EAMP, L.Ac. doane · Doane Seminars What is Medical Pulse Diagnosis ? - MPD is a tried and true SYSTEMATIC method that is the result of twenty years of high volume clinical experience.

All Rights Reserved. Copyright Lucky Falcon, LLC, d/b/a Doane Online Education 2018. Doane.us Doane Seminars

MPD™ (Medical Pulse Diagnosis) Seminar

Robert Doane EAMP, L.Ac.

Owner of the Acupuncture & Wellness Center, P.S.

Website: doane.us Email: [email protected]

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What is Medical Pulse Diagnosis ?- MPD is a tried and true SYSTEMATIC method that is the result of twenty

years of high volume clinical experience. The unique discoveries and cardiovascular emphasis of this method come from continually observing the same pulse signs and concurrent symptoms in thousands of patients. Modern medical research continues to support the clinical observations of MPD.

- The MPD pulse positions differ from most traditional pulse teachings and provide an advanced standardization of pulse locations for accurate diagnosis.

- The comprehensive pulse analysis informs the practitioner of the multiple pathological conditions influencing each patient’s disease expression. This comprehensive diagnosis guides the most effective MPD treatment strategies.

All Rights Reserved. Copyright Lucky Falcon, LLC, d/b/a Doane Online Education 2018.

Doane.us Doane Seminars

- It is clear that the majority of Chinese medicine practitioners lack confidence in their ability to correctly diagnose and treat patient illness in the clinical setting.

- For most, this is not due to a lack of intelligence or motivation, but rather an educational approach that insufficiently develops the diagnostic skills necessary to navigate complex patient cases.

- With dedicated learning, medical pulse diagnosis (MPD) will rapidly guide your success in the practice of Chinese Medicine.

Why is pulse diagnosis clinically important?


1. Learn MPD pulse positioning for reliable pulse diagnosis

2. Learn locations of all MPD pulse positions

3. Learn the anatomical correspondences of MPD pulse positions

4. Learn the healthy pulse presentation for each MPD pulse position

5. Learn the five pulse depths

6. Learn the pathological High and pathological Low pulses

7. Learn the pathological Forceful and pathological Forceless pulses

8. Learn the pathological Thick and pathological Thin Pulses

9. Learn the pathological pulses based on combo of Shape, Depth, Force, and Width

10. Learn the treatment strategies for common pulse presentations in each position

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MPD Seminar Goals



The 4 Modules of MPDModule 1: - 10 Steps to Accurate MPD Positioning

- Pulse Positions - Anatomical Correspondences and Conditions

Module 2: - Assessment of the Pulse Depth & Healthy Pulse

Presentation

Module 3: - Pathological Pulses based on Depth, Force, Width and

Shape

Module 4: - Common Pulse Presentations and Indicationss

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MPD Module 1

10 Steps to Accurate MPD Positioning

Pulse Positions - Anatomical Correspondences and Conditions


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- The following 10 steps outline the fundamental methods for accurate diagnostic positioning. The fulfillment of these 10 steps is essential for all further MPD diagnostic actions.

- Included in these descriptions are the common "pitfalls" that compromise the efficient practitioner and patient positions.

- With clinical experience, these steps will rapidly embed to memory and execute as second nature.

10 Steps to Accurate MPD Positioning


Step 1 - Patient’s hand in upright position


Step 1 Pitfall - Patient's hand presents in supine position


Step 1 Pitfall - Pulse taken from patient’s ventral side


Step 1 Pitfall - Pulse taken with patient’s palm facing upward and the diagnosing hand coming from ventral side


Step 2 - Stabilize the patient’s hand with a gentle, relaxed handshake


Step 2 Pitfall - Holding only the fingers of the patient’s hand

Just holding the fingers


Step 3 - Straight Wrist and Relaxed Forearm


Step 3 Pitfall - Unintended flexion of patient’s hand

Flexion of wrist


Step 3 Pitfall - Unintended hyperextension of patient’s hand

Hyperextension of wrist


Step 4 - Patient's thumb is down and relaxed


Step 4 Pitfall - Patient’s thumb is elevated


Step 5 - Anchor thumb of the diagnostic hand

- Anchor the thumb of the diagnostic hand securely on the dorsal aspect of patient's wrist in the region of acupoint SJ 4


Step 5 Pitfall - Thumb is not anchored


Step 5 Pitfall - Thumb is incorrectly anchored


Step 6 - Egg-Shaped Diagnosing Hand- This posture also places the center of the finger pads at a 45-degree angle on the radial artery. The center of the finger pads provides the highest level of tactile sensitivity during the diagnosis.


Step 6 Pitfall - Incorrect angle of diagnostic fingers


Step 6 Pitfall - Incorrect angle of diagnostic fingers


Step 6 Pitfall - Applying exaggerated pressure on the radial arteryNails are turning white – indicating too much pressure


Step 6 Pitfall - Finger pads placed too medialFingers placed on top of flexor carpi radialis tendon.

Flexor carpi radialis tendon


Step 7 - Styloid process identified and gapped


Step 7 Pitfall - Not gapping the styloid process


Step 8 - Identify the 5 Cun “Valley” pulse positions

1. Cun Pulse

2. Yin Wei Pulse

3. Large Vessel Pulse

4. Yang Wei Pulse

5. Mitral Valve Pulse


- Locate the Cun pulse in the central location of the Cun "valley" region between the proximal scaphoid bone and the distal styloid process.

- Rotate the index finger 30-40 degrees toward the patient's scaphoid bone (“Turn-the-key”)

Step 8 - Cun Position


Step 8 - Cun Position- An essential step in palpating the Cun Position requires shifting the Anchor thumb from SJ 4 to SJ 3.

- This shift provide the anchoring force and ability to properly rotate the index finger to correctly palpate the Cun position.


Step 8 Pitfall - The index finger is not rotated on the Cun Position


Step 8 - Yin Wei Position- The Yin Wei pulse is palpated medial to the Cun position, adjacent to

the flexor carpi radialis tendon.

- For Yin Wei palpation, the index finger pad is positioned perpendicularly, with no finger pad rotation.

Yin Wei Artery

*

*

Cun Pulse


Step 8 - Large Vessel Position - The Large Vessel pulse is located distal to the Yin Wei. This pulse is

situated at the wrist crease junction of the superficial palmar arch, the flexor carpi radialis tendon, and the scaphoid bone.

- Ensure that the finger pad is not on the flexor carpi radialis tendon or the scaphoid bone.

Large Vessel Pulse

*


Step 9 - Yang Wei Position- The Yang Wei pulse is lateral and slightly distal to the Cun pulse,

on the wrist crease.

- Note that the Yang Wei pulse is medial to the abductor pollicis longus tendon, not on the tendon.

Yang Wei Artery

*

*

Cun Pulse


Step 8 - Mitral Valve Position - In specific valve conditions, a distinct pulse is palpable on

the top of the abductor pollicis longus tendon.

*


Step 9 - Identify the Styloid and Guan Positions

guancun

styloid process

Apex styloid pulse

Proximal styloid pulse

Distal styloid pulse


Step 9 - Identify the Guan Position- The beginner MPD practitioner can locate and palpate the Guan pulse by "gapping" the styloid and then substituting the middle finger with the index finger in the Guan position.


Step 9 - Identify the Guan Position

cun

styloid process

- It is necessary that the diagnostic finger pad maintains a perpendicular position.


Step 9 Pitfall - Incorrect rotating of index finger at Guan Position


Step 10 - Identify the Chi and Proximal Positions- “Ruler Technique” for proper positioning

cunguan

guancun

chi

Styloid process


Step 10 - Identify the Chi Pulse and Proximal Pulses

cunguan

chi

proximal pulses


Step 10 Pitfall - Incorrect spacing between Guan Pulse and Chi Pulse

guancun

chi


guancun

chiproximal pulses

Location of the Cun, Guan, Chi and Proximal Positions


Avoiding Common Beginner Mistakes1. Ensure proper palpation of the 5 Cun position-related pulses (Cun Pulse, Yin Wei Pulse, Yang Wei Pulse, Large Vessel Pulse and Mitral Valve Pulse).

2. Upon analyzing the Cun Pulse, rotate the diagnostic hand's index finger pad 30-40 degrees distally, toward the scaphoid bone. Do not rotate the diagnostic fingers for the Styloid, Guan, Chi and Proximal Pulses.

3. The Large Vessel pulse is precisely located at the wrist crease junction of the superficial palmar arch, the flexor carpi radialis tendon, and the scaphoid bone. Compressed pen-tip pulses palpated distal or medial to this junction are not considered the Large Vessel pulse.

4. Do not confuse the Yin Wei Pulse or Yang Wei Pulse for the Cun Pulse. Palpate the Cun Pulse with the rotated finger pad in the central region of the Cun "Valley." Palpate the other pulses with the finger pad at the perpendicular angle.


5. Properly "gap" the radial styloid process to locate the Cun and Guan positions. With palpating the Guan position, ensure that the diagnostic finger pad is not on the Proximal Radial Styloid pulse.

6. Following the proper "gapping" of the radial styloid process, use the "Ruler technique" to correctly identify the Chi position. The Proximal Pulses are located immediately proximal to the Chi position and can extend several finger lengths in the proximal direction.

7. Improper positioning of the finger pads too medially, adjacent to the flexor carpi radialis tendon, compromises correct pulse diagnosis.

8. Palpate the pulses predominantly using the diagnostic hand's index finger pad. Include the other finger pads in the palpation of the Proximal Pulses or testing for particular pulse presentations to be described in future MPD texts. Do not palpate the pulses with an excessive pressure that occludes the radial artery.

Avoiding Common Beginner Mistakes


Pulse Positions Anatomical Correspondences and Conditions

- Each specific pulse position corresponds to distinct biophysical organ systems and anatomical regions of the body. The MPD analysis presents the structural and functional states of these particular anatomical components.

- This section describes the anatomical correspondences and conditions of each pulse position in detail. The beginner MPD practitioner must memorize these specific anatomical correspondences to diagnose patient conditions efficiently.



Right Arm Positions


Right Cun Position- Upper Respiratory Tract (Sinuses) - Head Trauma - Common Cold / Flu - Large Intestine (IBS, Colitis, Diverticulosis, Constipation, Intestinal Polyps, Hemorrhoids)


- Lower Respiratory Tract - All Lung Conditions - Asthma, Bronchitis, COPD, Sarcoidosis - Lung Phlegm - Lung Inflammation - Lung Blood Stasis

Right Yang Wei Position


Right Styloid Positions

guancun

styloid process

Apex styloid pulse

Proximal styloid pulse

Distal styloid pulse


Right Styloid Position

- Throat Conditions

- Thyroid Conditions - Hashimotos - Post Nasal Drip

- GERD, Esophageal Reflux


- Digestive Function - Chronic Gastritis - Gas & Bloating - Type 2 Diabetes - Stomach Polyps - Possible Aortic Aneurysm

Right Guan Position


-Urinary Tract Issues - UTI, Nephritis, Urinary Incontinence - Kidney Disease - Kidney Failure

- Conditions of Thoracic and Cervical region - Shoulder Dysfunction

Right Chi Position


-Urinary Tract Inflammation - Chemical Poisoning - Conditions of Thoracic and Cervical region - Cervical Spine Damage - Chronic Headaches / Migraines

Right Proximal Position



Left Arm Positions


Left Cun Position

- Condition of the Heart - Small and Large Vessel Blockages - Inefficient Blood Flow Through HT Chambers - Weak Heart - Ventricle / Atrial Function - Condition of the Small Int.


Yin Wei Position

- Hereditary Heart Conditions -(Shortness of Breath, Angina Pectoris Palpitations)


Large Vessel Position

- Large Coronary Vessel Pathology -(Spasms, Blockages)


Mitral Valve Position

**Note: this image demonstrates the Mitral Valve position on the Right Side

These indications apply to the Left side Mitral Valve Pulse

- Valvular Heart Pathologies

- Commonly Mitral Valve Dysfunction


Left Yang Wei Position

- Arthritis -(Degenerative or Inflammatory)


Left Styloid Position

- Diaphragm - Gastric Reflux - Hiatal Hernia


Left Guan Position

- Liver and Gallbladder - Hepatic Function - Fatty Liver - Gallstones Sympathetic NS


Left Chi Position

- Reproductive System - Endocrine System (esp. Adrenal function) - Lumbar/Sacral region - Hip / Knee / Ankle


Left Proximal Position- Low back pain - Uterine/ Ovarian Diseases - Chemical poisoning - Vasectomy - Genital Inflammation



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MPD Module 1 - Complete



MPD Module 2

Assessment of the Pulse Depth

Healthy Pulse Presentation



M

skin

superficial

middle

deep

bone

Five Levels of Pulse Depth



Five Levels of Pulse DepthSkin Level: Palpate the skin level by placing the diagnostic hand's finger pads on the skin above the pulse positions. No pressure is applied to perceive the pulse at this level. The skin level is a pathological pulse depth that invariably represents dysfunction of the corresponding organ systems/anatomical regions of the pulse positions.

Superficial Level: Palpate the superficial level with gentle pressure just below the skin level. This depth is the proper physiological depth of both the right and left Cun positions.

Middle Level: Palpate the middle level with gentle pressure below the superficial level. This depth is the proper physiological depth of both the right and left Guan positions.

Deep Level: Palpate the deep level with gentle pressure below the middle level. This depth is the proper physiological depth of both the right and left Chi positions.

Bone Level: Palpate the bone level with sufficient pressure to the level just above the radial bone. The bone level is a pathological pulse depth that invariably represents dysfunction of the corresponding organ systems/anatomical regions of the pulse positions.



Five Levels of Pulse Depth

First, identify the skin level by placing the diagnostic hand finger pads on the skin without applying pressure.

Second, identify the bone level by applying substantial pressure to the level just above the bone.

Third, locate the middle level in between the skin and bone levels.

The proper identification of these three levels provides a reference point for the location of all five depth levels.



Normal / Healthy Pulse Depths

M

skin

superficial

middle

deep

bone

- Note that the overall healthy pulse presents in a descending manner, from the Cun to Chi positions.

- This descending pulse presentation relates to the anatomical positioning of the radial artery.



Normal / Healthy Depth and Shape - Right and Left Cun Pulses

M

skin

superficial

middle

deep

bone

- The healthy pulse, of the right and left Cun position, is a slightly convex pulse at the superficial level.

- The strongest quality is palpable at the superficial level and decreases at the middle and deep levels. The healthy pulse is not evident in either the skin or bone levels.



Normal / Healthy Depth and Shape - Right Guan Pulse

M

skin

superficial

middle

deep

bone

- The physiological pulse of the right Guan is as a slightly convex pulse at the middle level.

This healthy pulse is not palpable above or below the middle level.



Normal / Healthy Depth and Shape - Left Guan Pulse

skin

superficial

mid

deep

bone

- The physiological pulse of the left Guan is a slightly wiry pulse at the middle level.

This healthy pulse is not palpable above or below the middle level.



Normal / Healthy Depth and Shape - Right and Left Chi Pulses

M

skin

superficial

middle

deep

bone

- The physiological pulse of the right and left Chi position is a slightly convex pulse at the deep level.

This healthy pulse is not palpable above the deep level.



Normal / Healthy Pulse Width- The width (thick or thin) quality of the pulse is relative to the

physical size and constitution of each patient.

- The categorization of body types into ectomorph, mesomorph, and endomorph is a simple tool for analyzing the overall pulse width.



Normal / Healthy Pulse Width

Mesomorphs - pulses neither too thin or thick.

Ectomorphs - pulses favors a slight thin quality.

Endomorphs - pulses favor a slightly thick quality.

The palpation of pulse widths that are dissimilar to the patient's size and constitution exemplifies a pathological condition.




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MPD Module 3

Pathological Pulses based on

Depth, Force, Width & Shape



MPD - Depth, Force, Width & Shape- Traditional pulse diagnostic methods provide a general diagnosis based on the impression of the overall pulse qualities.

- In comparison, MPD analyzes each pulse position in impressive detail for the accurate diagnosis of multiple organ systems and anatomical regions.

- In MPD the combination of the pulse depth, force, width and shape determine the specific Chinese medical and related western medical conditions.



Pathological Pulse Depths- The palpation of a pulse deviated from the proper "home" represents a dysfunction of the corresponding organ systems or anatomical regions.

- The pathological pulses are categorized based on the palpable level of depth; either too high or too low from the proper pulse "home."

- Each depth deviation represents a pathological process of the body.



High PulsesExcess Conditions

Excess Heat (Inflammation)

Excess Fire (Severe Inflammation)

Yin Deficiency with Increased Heat

Blood and Yin Deficiency

Deficiency Conditions



Low PulsesExcess Conditions

Dampness (Fluid Retention)

with Blood Stasis

Damp-Heat (Fluid Retention &

Inflammation) with Blood Stasis

Blood Stasis

Yang Deficiency with Blood Stasis

Deficiency Conditions



Pathological Pulse Force

- The resistance level of the pulse to pressure determines the pulse force.

- The healthy pulses, in the proper "home," preserve a balanced level of resistance to palpation, neither too much or too little.

- Forceful pulses maintain STRONG resistance to pressure. The forceful nature reflects a pathological EXCESS condition of either Heat or Cold.

- Forceless pulses fail to resist pressure and "give way" with no perceivable pulse underneath. The forceless nature reflects a pathological DEFICIENT condition of either Qi Deficiency, Yang deficiency, Blood Deficiency, Yin Deficiency, Yin deficiency with Increased Heat or a combination thereof.



Pathological Pulse Force - Example

Excess Deficient



Pathological Pulse Width- The healthy Width (thick or thin) quality of the pulse is relative to the physical size and constitution of each patient.

- Pulses that are too thick are the result of either Excess Heat, Excess Fire or Qi Deficiency.

- Thin - Forceful pulses that maintain resistance to pressure are due to Excess Cold or Blood Stasis with Excess Cold.

- Thin - Forceless pulses that "give way" with pressure are due to Yang Deficiency, Blood Deficiency or Yin Deficiency.



MPD - Shape, Depth, Force & Width- The convex, wiry and blocked pulse shapes are a significant component in determining the correct MPD diagnosis. The combination of these pulse shapes with specific pathological pulse depths, levels of resistance (force) and pathological pulse widths accurately establishes the diagnosis and relevant treatment strategy.

- For example, the Deep - Forceful - Thin - Wiry pulse represents Blood Stasis with Excess Cold. When located in the female left Chi and Proximal position, this pulse quality represents Blood Stasis with Excess Cold affecting the reproductive system. These patients manifest the pain and menstrual symptoms associated with endometriosis.



Pulse ShapeThere are 3 basic pulse shapes which provide critical diagnostic information in combination with the pulse depth, force, and width.

1. Convex Pulses 2. Wiry Pulses 3. Blocked Pulses

The convex, wiry and blocked pulse shapes are a significant component in determining the correct MPD diagnosis.



Convex Pulses- The healthy convex pulse is the normal shape of all the pulse positions, except the left Guan.

Convex (Healthy)

Convex and Thin

Convex and Thick



Wiry Pulses- The healthy wiry pulse is the normal shape of the left Guan.

Wiry (Healthy)

Wiry and Constricted (Extremely thin)

Wiry and Thin

Wiry and Thick



Blocked Pulses- Blocked pulses are palpable as deep and amorphous in quality. In these cases, the radial artery lacks definite shape and boundaries. The amorphous quality compares to placing the fingers on Jello.

- The Blocked pulses are categorized on a scale of 1 to 3, relative to the palpable quality of blockage.

Stage 1 Stage 2 Stage 3



Compressed Pulse- Compressed pulses represent tissue aggregations that obstruct optimal blood circulation to specific organ systems and anatomical regions.

- The location of the Compressed pulses is within the various fascial tissue layers intimately connected with the radial artery.

Small Compressed:

Small compressed pulses of hard quality represent the most severe degree of tissue aggregation and potential malignancy.



Compressed PulseMedium Compressed:

These pulses are commonly found in the right and left Chi positions and represent inflammatory pain conditions of these specific myofascial tissue regions.

Large Compressed:

The larger compressed pulses that occur with the Excess Heat (inflammation) pulse in the Chi positions, represent active inflammation and pain.

Large-Extended:

The large compressed pulses that extend from the Chi to the Proximal positions represent inflammatory pain conditions of an expansive myofascial tissue region.



Systemic Pulses

- The Systemic Pulses represent pathologies that affect the entire radial pulse presentation. Each of these pathologies relates to a specific dysfunction of the heart or systemic cardiovascular dysfunction that can have a widespread impact on multiple health systems.

1. Up-Down Pulse 2. Viscous Blood Pulse 3. Stiff Pulse 4. Thick-Swollen Pulse



Up-Down Pulse

- The diagnostic fingers sharply elevate during the ascending phase of the pulse wave and then collapse in the descending phase. This creates a mechanical up-down sensation along the radial artery.

- This quality can result from an aortic valve regurgitation, generally due to aortic valve insufficiency and aortic stenosis, most common in patients of senior age.



Viscous Blood Pulse- The viscous-blood pulse indicates a higher density of particles in the bloodstream.

- This issue can result from high blood lipids and glucose from poor diet, accumulated toxins/waste products, and blood disorders in which abnormal blood cell production is involved.

- In this case, the vessel boundaries are clearly palpable, but the fluid within the artery feels thick, viscous and sluggish.



Stiff Pulse- The stiff pulse represents the hardening of the arterial vessel system. With this pulse, the entire radial artery is palpable as a hard, slightly thick, wiry pulse that is resistant to pressure.

- This compromised vessel structure limits optimal blood circulation to both internal and external regions of the body and may provoke a myriad of health conditions.



Thick-Swollen Pulse- The thick-swollen pulse represents a systemic narrowing of the inside diameter of the arterial walls due to inflammation and cell proliferation.

- With this pulse, the entire radial artery wall feels slightly thick and swollen. Increased palpatory pressure also demonstrates a spongy quality of the vessel wall.




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MPD Module 4

Common Pulse Presentations

& Indications



Common Pulse Presentations & Indications

Left Arm Pulses



Left Cun - Normal / Healthy Pulse

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Left Cun1. Reverse Hook Pulse 2. High - Forceless - Thin - Wiry Pulse 3. Blocked Pulse (Stage 1-3) 4. Blood Stasis with Excess Cold Pulse 5. Up-Down pulse 6. Low - Forceless - Thin - Wiry 7. Enlarged Heart Pulse 8. Extended - Convex Pulse 9. Yin Wei Pulse 10. Mitral Valve pulse 11. Large Vessel pulse 12. Yang Wei Pulse (Arthritis Conditions)



Reverse Hook PulseThe Chi pulse is higher (more superficial) than Cun and Guan

Indications: - Chronic Stage 3 Stress (Fight or Flight)

- Long-term emotional imbalance – existential uneasiness, anxiety

- Adrenal glands are too active or exhausted from past frightening situations Chronic Stage 3 Stress (Fight or Flight)



Herbal Treatment:

Normal/Warm hands: - Tian Wang Bu Xin Dan - 40 - Sheng Mai San - 40 - Zhi Bai Di Huang Wan - 20

Cool/Cold hands: - Long Dan Xie Gan Tang - 50 - Ba Wei Di Huang Wan - 50

Reverse Hook Pulse



High - Forceless - Thin - Wiry Pulse

Blood Deficiency (Anemia – Functional Deficiency)

Indications: - Heart blood def. - poor memory, - poor concentration - ADD - lack of concentration


High - Forceless - Thin - Wiry PulseHerbal Treatment:

- Ren Shen Yang Ying Tang - Shi Quan Da Bu Tang - Tian Wang Bu Xin Dan

- Check Left Guan if (High – Forceful) Modify the formula to include Chai Hu Jia Long Mu Tang (33% to 50% of the formula)


ADD - overactive - concentration issues:

- Tian Wang Bu Xin Dan is not strong enough - Use Shi Chang Pu, Yuan Zhi, Suan Zao Ren, Lian Zi Xin - Add Tian Zhu Huang if you find a slippery pulse (brain damage pulse)

- Pay attention to the Left Guan. You have to treat he liver if it is overactive: Use Liver Detox or Zhi Zi - Heart palpitations: Can combine with Tian Wang Bu Xin Dan with Zhi Gan Cao Tang

High - Forceless - Thin - Wiry Pulse


Blocked Pulse (Stages 1-3)

Blood stasis (circulatory occlusion) and Dampness (fluid retention)

Indications: - Vessel blockage, either large or small - Bundle branch block


Herbal Treatment:

- Mao Dong Qing - 25% - Dan Shen - 25% - Gua Lou Xie Bai Ban Xia Tang - 25% - Stress 1 - 25%

With Anxiety – Add Ye Jiao Teng

Other possibilities: - San Qi - Shan Zha - Yan Hu Suo

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Blood Stasis with Excess Cold Pulse

Blood Stasis (Circulatory Occlusion) w/ Excess Cold (Vasoconstriction)

Indications: - Severe coldness in the heart - Angina pectoris - Myocardial infarction - Coronary heart conditions



Herbal Treatment:

- Si Ni Tang - 20 - Stress 1 - 20 - Dan Shen - 20 - Gua Luo Xie Bai Ban Xia Tang - 20 plus Openers: Dang Gui - 10, Chuan Xiong - 10 (or Sheng Ma 10)

Herbs that clear the plaque on the vessel wall: Shan Zha, Jue Ming Zi, He Ye, Xia Ku Cao, San Qi, Dan Shen


Up-Down PulseBoth the upward (systolic) and downward (diastolic) aspects of the pulse are palpable

- Can be felt in all pulse positions

• Indications: - Heart valve problems - Aortic valve regurgitation, stenosis; - Shortness of breath, chest pain, fainting, dizziness

- MSG, soda, or coffee intake


Herbal Treatment:

- Mao Dong Qing - 50 - Excellent for water retention in the chest/heart and Edema caused by heart dysfunction (i.e. congestive heart failure) - Tian Wang Bu Xin Dan - 25 - Yang Xin Tang - 25

Can also use: Mao Dong Qing - 100

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Up-Down Pulse


Low - Forceless - Thin - Wiry Pulse

Indications: - Congestive heart failure (pre-clinical) - Fluid in the lungs - Edema in the ankles (systemic edema)


Herbal Treatment: - Si Ni Tang - 20, - Fang Ji Huang Qi Tang - 20 - Xue Fu Zhu Yu Tang - 40 Usually with anxiety: Add - Yan Hu Suo - 15 and He Huan Pi - 15

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Enlarged Heart PulsePulse Quality – the pulse “balloons” up against your finger up when you slowly lift your finger up

Herbal Treatment: (use Astringents)

- Wu Wei Zi - 10 - Tian Hua Fen - 10 - Ba Wei - 10 - He Zi - 10 - Wu Bei Zi - 10 - Ce Bai Ye - 15 - Lian Zi Xin - 15 - Zhen Ren Huo Ming Yin - 35


Extended - Convex Pulse

Pulse extends distally beyond the Cun position. Slightly firm pulse quality.

• Indications: • - Relates to Small

Intestine - Gas, bloating, enteritis - Food poisoning or colitis


Herbal Treatment:

Gas, bloating, enteritis: - Ge Gen Huang Qin Huang Lian Tang - 25% - Shao Yao Tang - 35% - Astringent Complex or Herbal ABX - 40%

Food poisoning or colitis: - Add Herbal ABX, all equal percentage (25%)

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Extended - Convex Pulse


Mitral Valve PulsePlace the index finger pad on top of the abductor pollicis longus tendon with light pressure, then gradually increased pressure.

Indications: - Anxiety - Sleeping problems / insomnia - Paroxysmal irregular heartbeat - Arrhythmias

*

Note: this image demonstrates the Mitral Valve position on the Right Side - These indications apply to the Left side Mitral Valve Pulse


– If the Left Cun is Blocked - – Treat the blocked pulse as the priority

Herbal Treatment:

- Mao Dong Qing - 50 - San Qi - 25 - Jiang Huang - 25

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Mitral Valve Pulse


Large Vessel PulseThe Large Vessel Pulse is at the wrist crease, and the index finger pad is rotated slightly toward the patient's scaphoid bone to analyze this junction.

Indications: - (Preclinical) Coronary Artery Disease


Large Vessel PulseHerbal Treatment:

- Dang Gui - 15 - Chuan Xiong - 15 - Wang Bu Lu Xing - 15 - Tao Ren - 10 - Pu Huang - 10 - Shui Zhi - 10 - Xue Fu Zhu Yu Tang - 15 - Dan Shen - 15


Left Yang Wei PulseThe lateral continuation of the radial artery is the Yang Wei pulse.

Indications: - Arthritis

Forceful - Convex: Heat - Inflammatory Arthritis

Forceful - Thin - Wiry: Cold - Osteoarthritis


• Herbal Treatment:

Forceful - Convex Pulse: Heat condition - Dang Gui Nian Tong Tang - 50 - Astringent Complex - 50

Forceful - Thin - Wiry Pulse: Cold condition - Shu Jing Huo Xue Tang - 50 - Shen Tong Zhu Yu Tang - 20 - Ru Xiang - 15 - Mo Yao - 15

125

Left Yang Wei Pulse


Left Guan - Normal / Healthy Pulse


1. High - Forceful - Convex or Wiry Pulse 2. Low - Forceful - Wiry Pulse 3. a) Low - Forceful - Thick - Convex b) Blocked Pulse 4. Compressed pulse

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Left Guan


High - Forceful - Convex or Wiry PulseExcess Heat (Inflammation)

Indications: - Emotional aspect of Liver involved: stress, irritability, excessive thinking, nervousness, mood swings, insomnia - Positive type of emotional condition - patient does not hold feelings inside. Most likely would like to argue or fight with others.


Herbal Treatment:

- Jia Wei Xiao Yao San - 33 - Chai Hu Jia Long Mu Tang - 33 - Yi Gan San 33 for fast heart rate

If that does not work – Alternative: - Zhi Zi - 15 - Hu Zhang - 15 - Huang Shui Qie - 15 - Xia Ku Cao - 15 - Long Dan Xie Gan Tang - 20 - Astringent Complex - 20

If no emotional conditions, just fatigue/tired - Chai Hu Qing Gan Tang or Liver DTX - 50 - Wu Wei Zi - 25 - Shan Zhu Yu 25

High - Forceful - Convex or Wiry Pulse


Low - Forceful - Wiry

Indications: - Actual Liver organ function disorders: hepatitis, elevated Liver enzymes

- Very thin at middle or deep depths is usually due to mononucleosis in the past


Herbal Treatment:

Actual Liver disorder: - Liver DTX - 30 - Ge Xia Zhu Yu Tang - 20

High Liver enzymes: - Add Chai Hu Qing Gan Tang 20 - Wu Wei Zi 15 - Shan Zhu Yu 15

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Low - Forceful - Wiry


a) Blocked Pulse b) Low - Forceful - Thick - Convex

Indications: - Fatty Liver - Emotional conditions: depression (blocked) and or frustration (low - convex), anxiety, irritability


Herbal Treatment:

a) Blocked Pulse: - Ge Xia Zhu Yu Tang - 50 - Long Dan Xie Gan Tang - 50

b) Low- Forceful - Thick - Convex - Ge Xie Zhu Yu Tang - 20 - Yin Chen Hao Tang - 20 - Long Dan Xie Gan Tang - 20 - Liver DTX - 40

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a) Blocked Pulse b) Low - Forceful - Thick - Convex


Compressed Pulse

Indications:

Gallstones; Sludge in the Gallbladder Hepatic Cyst


Herbal Treatments:

Gallstones use: - Dissolve (GS)

Hepatic Cyst use: - Dissolve (GS) - 50 - Fu Yuan Huo Xue Tang - 50

Compressed Pulse


Left Chi - Normal / Healthy Pulse

M

skin

superficial

middle

deep

bone


Left Chi

1) Low - Forceless - Thin - Convex or Wiry Pulse 2) Compressed Pulse 3) Large Compressed Pulse 4) Blocked Pulse 5) High - Thin - Wiry Pulse (Forceful or Forceless)


Low - Forceless - Thin - Convex or Wiry Pulse

Functional Deficiency w/ Cold signs

Indications: - Infertility - Low libido - Impotence


Herbal Treatment:

- You Gui Wan - 20 - Ba Wei Di Huang Wan - 20 - Shao Fu Zhu Yu Tang - 20 - Ba Ji Tian - 10 - Rou Cong Rong - 10 - Bu Gu Zhi - 10 - Yin Yang Huo - 10

Low - Forceless - Thin - Convex or Wiry Pulse


Compressed Pulses

Indications: - Kidney stones in the left ureter

- Scar tissue from an abortion, hysterectomy,C-section, IUD, tied tubes, any lower abdominal surgeries.


Compressed Pulses

Herbal Treatment:

KD Stone: Dissolve KS - 100

Reproductive Issue: If no jump to the pulse: - Cold Breakers - 20 - Shao Fu Zhu Yu Tang - 40 - Zhe Chong Yin - 20 - Ge Xie Zhu Yu Tang - 20

If jump to the pulse: - Warm Breakers - 20 - Da Ding Huang - 10 - Zhen Ren Huo Ming Yin -

30 - Resolve EM - 40


Large Compressed PulsesIndications: - Tissue damage; overuse or repetitive movements

- Extended Large Compressed Pulse: Bone spurs, Lumbar spine problems

- Bilateral Chi position = Prostate enlargement, varicocele


Large Compressed PulsesHerbal Treatment:

Soft tissue damage - Astringent Complex - 60 - Zhen Ren Huo Ming Yin - 25 - Dang Gui Nian Tong Tang - 15 - for lower body(for upper body, use Er Zhu Tang + Flex (Spur)

Bone spurs or disk problems (Extended Large Compressed Pulse) - Flex (Spur)

Prostate enlargement (Bilateral Chi) - Resolve (Lower) - 50 - Astringent Complex - 50


Blocked Pulses

Blood stasis (circulatory occlusion) and Dampness (fluid retention)

Indications: - Blood stasis from older trauma - low back pain - Lower abdominal surgery, abortion, C-section, IUD, hysterectomy


Blocked PulsesHerbal Treatment:

- Circulation SJ - 50 - Resolve (Lower) - 50

Vasectomy: A bump between Guan and Chi in men may indicate vasectomy

or swelling in the genital area

Hot condition – swollen, inflammation Hot Breaker (Xia Ku Cao, Xuan Shen, Huai Hua)

Cold condition – blockage with no heat Cold Breaker (Wang Bu Liu Xing, San Leng, E Zhu)


High - Thin - Wiry Pulse (Forceful or Forceless)

Indications: - Forceless: (KD Yin Deficiency) - Forceful: Kidney Yin Deficiency with Increased Heat

Herbal Treatment:

- Zhi Bai Di Huang Tang - 50 - Zuo Gui Wan - 50


Left Proximal Position - Pulses Extend Proximal

1. High - Forceful - Thick - Wiry

2. High - Forceful - Slightly Thick or Thin - Wiry

(Common in Middle Depth)

3. Low - Forceful - Thin - Wiry


High - Forceful - Thick - Wiry Indications: - Reproductive dysfunctions - Chemical sensitivities/heavy metal poisoning - Inflammation in lower abdomen

On both chi positions (in women) - If palms are hot → ask if taking hormones → If yes, possible high risk of breast cancer, too much estrogen


Herbal Treatment:

- Seattle 1 Complex - 60 - Astringent Complex - 20 - Ba Zheng San - 20

High - Forceful - Thick - Wiry


High - Forceful - Slightly Thick or Thin - Wiry

Indications: - Back pain - Stiffness, Strain, Sprain


High - Forceful - Slightly Thick or Thin - Wiry Herbal Treatment:

Pulse shows increased inflammation: - Seattle 1 - 33 - Astringents - 33 - Dang Gui Nian Tong Tang - 33

Pulse is stiff - Cold signs: - Cold breakers - 20 - Flex Spur - 30 - Shu Jing Huo Xue Tang - 20 - Ru Xiang - 15 - Mo Yao - 15


Low - Forceful - Thin - Wiry


Women: Abortion scar, tubes tied, C-section

Men: Vasectomy

Blocked Pulse: Back surgery, hysterectomy, blood stasis

PCOS/ Endometriosis

Women: PCOS

Endometriosis, painful periods



Herbal Treatment:

- Resolve EM - 40 - Cold Breakers - 20 - Shao Fu Zhu Yu Tang - 20 - Zhe Chong Yin - 20

154




Common Pulse Presentations & Indications

Right Arm Pulses



Right Cun - Normal / Healthy Pulse

M

skin

superficial

middle

deep

bone



1. High - Forceful - Thick - Convex Pulse

2. Low - Forceless - Thin - Wiry Pulse

3. a) High - Forceful - Thin - Wiry Pulse

b) High - Forceless - Thin - Wiry Pulse

1. Blood Stasis with Excess Cold Pulse

2. Blocked Pulse (Stages 1-3)

3. Compressed Pulses

4. Yang Wei Pulse Presentations (Lower Respiratory)

Right Cun



High - Forceful - Thick - Convex PulseExcess Heat (Inflammation)

Indications: - Upper respiratory infection (bacterial or viral) - Sinus Infection

*** Patients with a exterior-wind pattern the pulse will be more wiry.

- For all exterior-wind invasions, at least the first week, exterior releasing herbs MUST be used.

- Ge Gen Tang 20% of the formula (If the nose and cheeks are cool or cold) - Yin Qiao San 20% of the formula (If the nose and cheeks are warm or hot)



Exterior Conditions continued:

- If the pulse is High - Forceful - Wiry: Yin Qiao San 40, ABX 20, Pu Ji Xiao Du Yin 20. (Add Lung PH if there is some cough 20 grams more)

- If the pulse is High - Forceful - Convex: Resolve EM 40, ABX 15, Astringent 15, Gardenia or Seattle complex 15, Huang Lian Shang Qin Wan 15. (this is for a sinus infection)

- If the pulse is High - Thin - Wiry: Ge Gen Tang or Gui Zhi Tang 35, Yin Qiao San 20, ABX 15, Astringent to stop nasal drip 15, along with Er Chen Tang 15



Exterior Conditions continued:- Dry cough usually combined with ST-fire (High - Forceful - Thick - Convex in Right Guan) Moisten dryness and clear ST-fire - Qing Zao Jiu Fei Tang

- Stomach Fire often is associated with exterior heat or wind heat. - ST 8 hot = Stomach Fire

Which taste moistens dryness? - Acrid, cold (for dry fire) and salty (for fire) - Salty and cold (pulse is strong at all depths): Fu Hai Shi, Hai Ge Fen, Di Long - Acrid and cold (pulse is strong mostly at the higher depth): Da Qing Ye, Niu Bang Zi



Exterior Conditions Summary

- Use 30% to 40% of formula to release exterior Yin Qiao San and Ge Gen Tang

- If Nose and/or cheeks are cold, use Ge Gen Tang. - If they are extremely cold use Xiao Qing Long Tang - If the nose and cheeks are hot, use Yin Qiao San





Indications: - Upper respiratory infection (Viral) - Flu - Wei Qi (Immune) Deficiency



Low - Forceless - Thin - Wiry Pulse- Pu Ji Xiao Du Yin - 20 BEST for viral infection. (Yin Qiao San is for bacterial infection.) - Yu Ping Feng San - 20 - Qing Fei Tang - 20 - Astringent Complex - 20 - Ge Gen Tang - 20

Loss of Voice: - Add He Zi - 15 and Jie Geng Tang - 20 (contains Jie Geng 10% and Gan Cao 10%) - Can also use: Shi Wei - 6, She Gan - 6, Jie Geng - 6



a) High - Forceful - Thin - Wiry Pulse b) High - Forceless - Thin - Wiry Pulse

Specific to the right Cun, the high - wiry pulse represents an active immune system engagement (wind invasion). The immune system responds to pathogenic invasions (e.g. common cold/airborne allergens).

Allergies: 3 Types

- Acute Wind Heat (High - Forceful - Sl. Thick - Wiry) (Potential slight Convex)

- Acute Wind Cold (High - Forceful - Thin - Wiry)

- Chronic allergies with Lung Qi Deficiency (High - Forceless - Thin - Wiry)



a) High - Forceful - Thin - Wiry Pulse



a) High - Forceful - Thin - Wiry PulseWind Cold: Cang Er San – 30 Gan Cao – 5 Jing Jie – 10 Bai Zhi – 10 (for runny nose) Jie Geng – 10 Astringent Complex – 10 Fang Feng –10 Chan Tui – 5 Si Ni San – 10

Wind Heat: (or more severe sx’s) - Pulse may be slightly thick and convex (Heat) Mu Dan Pi – 15 Lian Qiao – 10 Sheng Ma – 10 Bai Zhi – 5 (increase to 15 if runny nose) Xin Yi Hua – 10 Chuan Xiong – 5 Lu Lu Tong – 10 E Bu Shi Cao – 5 Cang Er Zi – 10 Gan Cao – 5 Chan Tui – 5 Huang Qin – 10

If eyes are affected, add: Ju Hua, Sang Ye, Bai Ji Li



b) High - Forceless - Thin - Wiry Pulse



b) High - Forceless - Thin - Wiry PulseChronic allergies with Lung Qi Deficiency: Use any one of the following 2 formulas as 20% of your allergy formula. - Huang Qi Jian Zhong Tang - Yu Ping Feng San

Allergies (Wind) plus Fatigue: Yu Ping Fen San or Huang Qi Jian Zhong Tang,– 30 Chan Tui – 10 Xin Yi Hua – 10 Jie Geng – 5 Dang Shen – 5 Bai Zhi – 10 Wu Mei – 5 Gan Cao – 5 He Zi – 10 Wu Bei Zi – 10

If wheezing: Add Di Long – 6g, Ku Shen – 6g If loose stools: Add Ge Gen – 15g If blood stasis: Add Mu Dan Pi – 8g, Dang Gui – 5g, Lu Lu Tong – 6g




Blood Stasis (Circulatory Occlusion) w/ Excess Cold (Vasoconstriction)

Indications: - Wind-cold (if superficial) or

- Lung-cold with phlegm (deeper)

- White sputum / post nasal drip / nasal discharge




- Xiao Qing Long Tang - 20% - Si Ni Tang (in winter or cold climate area) 20%

- Openers: Dang Gui 15% and Sheng Ma 15% (or Dang Gui 15% and Chuan Xiong 15%). - Opens up and promotes circulation in the capillaries, small vessels. Transport the WBC, RBC, etc to the area.

- Astringent Complex 30% for inflammation (to bring all the wiry pulses inside together)

- Headache: Add Chuan Xiong Cha Tiao San - Runny Nose: Add add E Bu Shi Cao and Bai Zhi






Blocked Pulse (Stages 1-3)The Blocked pulses represent varying levels of blood stasis (circulatory occlusion) and dampness (fluid retention).

Indications: - Sinus infection - Vertigo or dizziness - Head pain due to micro-capillary bleeding leading to dead blood in the sinus and head area - Polyps in Large Intestine

Causes include: - Traumatic injury to the head -Drinking cold/ice water on a hot day or after exercise - Holding breath for too long - Lifting heavy objects/weights, Weight lifters




Head Trauma: - Stress 1 - 40 - Tong Qiao Huo Xue Tang - 20 - Seattle 1 - 40

Sinus infection, i.e. cheeks are very hot: Resolve EM- 40 Herbal ABX - 15 Astringent Complex - 15 Huang Lian Shang Qin Wan - 15 Seattle 1 - 15



Dizziness/Vertigo from phlegm in the eustachian tubes:

Bai Zhu - 20 Ban Xia - 20 Tian Ma - 20 Fu Ling - 20 Ze Xie - 20




Compressed Pulses



The Compressed pulses represent tissue aggregations that obstruct optimal blood circulation to specific organ systems and anatomical regions.

Determine firmness of the compressed pulse - Soft and can be pushed away – mild condition such as a soft polyp or hemorrhoid - Hard and resistant to pressure– severe condition, may be a stronger obstruction in the large intestine

Indications: - Polyps in the Large Intestine - Hemorrhoids (if the short pulse is very small)

Compressed Pulses



Compressed PulsesWith High - Forceful - Convex Pulse = Fire in LI (Constipation w/ dryness) The more floating → more dryness and fire in body

Indication: - Diverticulosis - Enteritis

Herbal Treatments for Large Intestine Problems:

1. Diverticulosis/ Large or small polyps: -Zhen Ren Hou Ming Yin 20, Astringents 20, Cold Breakers (if no jump)/ Warm Breakers (if there is a jump/amplitude) 20, Ge Xie Zhu Yu Tang 20, Cha Chi Huang 20 (or Huang Qin).



Compressed Pulses

Herbal Treatments for Large Intestine Problems continued:

2. IBS: Ge Gen Huang Lian Tang 30, Jia Wei Xiao Yao San 20, Xian Sha Liu Jun Zi Tang 20, Shan Zha 15, Mai Ya 15.

If the stomach pulse is very wiry and strong: He Zi 15, Wu Bei Zi 15, Bai Wei 15, Tian Hua Fen 15, Huang Lian Jie Du Tang 20, Jia Wei Xiao Yao San 20

3. Constipation: Add Da Huang 8g, Mang Xiao 8g.



Compressed Pulse - Right Yangwei



Indications: Phlegm Block or Asthma Condition (Obstruction)

Acute Asthma: Cold condition with runny, white, clear phlegm and a cool Ren 22 - Xiao Qing Long Tang 50, Astringents 30, Zi Wan 10, Bai Bu 10

Hot condition with thick, yellow, sticky phlegm and a warm Ren 22 - Ding Chuan Tang 50, Di Long 10, Lung Ph 20, Qian Hu 20

Compressed Pulse - Right Yangwei



Compressed Pulse - Right YangweiAsthma: Forcless Compressed Pulse and Forceless Right Guan Pulse

Zhi Huang Qi – 15 Zhi Gan Cao – 5 Chan Tui – 5 Bai Zhu – 5 Ling Zhi – 15 Dang Gui – 5 Dan Shen – 10 Fang Feng – 5 Astringent Complex – 10 Chen Pi – 15 Ban Xia – 5 Ku Shen – 5

Asthma: Late onset with lower back problems

Zhi Huang Qi – 15 Ling Zhi – 10 Shan Zhu Yu – 5 Tu Si Zi – 5 (Zi) Su Zi – 5 Chen Pi – 5 Astringent Cplx – 10 Zhi Gan Cao – 5 Shu Di Huang – 10 Ge Jie – 5 Dong Chong Xia Cao – 5 Bu Gu Zhi – 5 Ku Shen – 5 Fu Ling – 5 Dan Shen – 5

181



Right Yang Wei Pulses



Right Yang Wei Pulses

Indications: - On right side: Lower respiratory conditions – bronchitis, deep cough, phlegm congestion in Lung - Ren 22 feels hot – heat condition - Ren 22 feels cold – cold condition

Forceful - Convex Pulse and Ren 22 is warm - Phlegm Heat in Lung Forceful - Thin - Wiry Pulse and Ren 22 cold - Phlegm Cold in Lung



Right Guan - Normal / Healthy Pulse

155

M

skin

superficial

middle

deep

bone



Right Guan

1. High - Forceful - Thick - Convex Pulse 2. High - Forceful - Thick - Wiry Pulse

3. Low - Forceful - Thick - Wiry Pulse 4. Blocked Pulse

5. Low - Forceful - Thick - Convex Pulse 6. Forceless - Thin - Wiry Pulse



High - Forceful - Thick - Convex PulseExcess Heat (Inflammation)

Indications: - Acid reflux, H. pylori, bacterial infection - s/s: stomach pain, burning sensation in the abdominal area, nausea, frequent belching

- If LI-10 feels cold concurrent to this pulse - then a constitutionally cold stomach has been invaded by a heat pathogen. Add 20% of a warm digestive tonic to the formula.



Herbal Treatment:

- Astringent Complex - 40 (anti-inflammatory formula for acute and chronic inflammation) - Herbal ABX - 20 - Huang Lian Jie Du Tang - 20 - Jia Wei Xiao Yao San - 20 (add An Zhong San if LI area is cold)

Check temperature of LI-10 and palm If both regions have varying temperatures - Parasites - Chronic fatigue - Poor digestion - Sleeping disorders - Might need anti-parasitic drugs - works best for Giardia or Entameba Histolytica

High - Forceful - Thick - Convex Pulse



High - Forceful - Thick - Wiry Pulse

Excess Heat (Inflammation) & Secondary Stagnation

Indications: - Duodenal ulcer (due to nervous tension) - Stomach pain - Acid reflux - Emotional stress ulcer. LR overacting on ST

- If hollow pule quality → bleeding with ulcer



Herbal Treatment: - Feng Wei Cao - 15 (for inflammation of the stomach only) - Zhen Ren Huo Ming Yin - 20 (to stop pain) - Chai Hu Jia Long Mu Tang - 20 - Astringent Complex - 15 - Zhe Chong Yin - 15 to stop pain - Huang Lian Jie Du Tang - 15 - Add Jia Wei Xiao Yao San if too emotional

If that previous formula does not work then use: - Hu Zhang - 15 - Xia Ku Cao - 15 - Cha Chi Huang - 15 - Huang Shui Qie - 15 - Jia Wei Xiao Yao San - 20 - Huang Lian Jie Du Tang - 20




Jia Wei Xiao Yao San and Yi Gan San: - For emotional aspects of Liver problem. - Both spread Liver qi stagnation and calm the shen - Do not help with the stomach pain.

- Yi Gan San is better than Jia Wei Xiao Yao San if the patient also has fast heart rate or trembling. - Jia Wei Xiao Yao San is safe for long term use.

Acid Reflux and Bloating: Add Chai Hu Jia Long Mu Tang - Good if acid reflux is severe - Protects ST lining damage

Also effective for acid reflux is combination - Wa Leng Zi and Mu Li If LI-10 is cold: Add An Zhong San




Low - Forceful - Thick - Wiry Pulse

Blood Stasis (Circulatory Occlusion) & Secondary Damp-Heat (Fluid Retention and Inflammation)

Indications: - Diet high in sugar or carbohydrate intake - Pre-diabetic - May have Type II diabetes



Herbal Treatment:

- M3 (Xie Huang San, Gan Lu Yin, Huang Lian Jie Du Tang-all equal amounts ) - 40 (for stomach fire) - Hu Zhang - 15 - Huang Shui Qie - 15 - Cha Chi Huang - 15 or Zhi Zi - 15 - Xia Ku Cao - 15

Low - Forceful - Thick - Wiry Pulse



Blocked Pulse

Blood Stasis (Circulatory Occlusion)

Indications: - Poor digestion– gas, bloating, belching - Chronic superficial gastritis (if pulse is forceful)



Blocked Pulse

Herbal Treatment:

- Huang Lian Jie Du Tang - 20 - Ge Xie Zhu Yu Tang - 20 - Astringents -60



Low - Forceful - Thick - Convex Pulse

Blood Stasis (Circulatory Occlusion) w/ Damp-Heat (Inflammation)

Indications: - Poor digestion– gas, bloating, belching - Chronic superficial gastritis (if pulse is forceful)



Superficial Gastritis

Herbal Treatment - for both pulse types representing Superficial Gastritis:

- Astringent Complex - 40 - Herbal ABX - 20 - Chai Hu Jia Long Mu Tang - 20 - Huang Lian Jie Du Tang - 20



Forceless - Thin - Wiry Pulse


Indications: - Middle jiao deficiency – deficient-cold in Stomach - Usually found in very weak people, post surgical, lupus, etc. - Weak digestion, trouble digesting raw food (LI10 area is cold)



Herbal Treatment: - An Zhong San for cold stomach - Gui Pi Tang for weak stomach. - Can add Jia Wei Xiao Yao San to build the middle Jiao and replenish an exhausted mind—good for students who have a cold, weak digestive system - Fu Zi Li Zhong Tang for a very cold stomach

Best way to tonify the middle jiao is to change the diet

Herbal Treatment: An Zhong San 50%, Jia Wei Xiao San 20%, Gui Pi Tang 30%. - Substitute An Zhong San with Fu Zi Li Zhong Tang - if the pulse is very thin like the edge of a piece of paper and disappears with any pressure.

Forceless - Thin - Wiry Pulse



Right Chi Normal / Healthy Pulse

M

skin

superficial

middle

deep

bone



Right Chi

1. Small Compressed Pulse

2. Large Compressed Pulse

3. Blocked (Stage 1-3) Pulse



Small Compressed Pulse

Indications: - Kidney Stone in the right Ureter



Herbal Treatment:

- Dissolve (KS) If Kidney cyst: Add Hot or Cold Breaker - Hot Breaker – Huai Hua, Xuan Shen, Xia Ku Cao, Zhe Bei Mu - Cold Breaker – San Leng, E Zhu, Wang Bu Liu Xing

- Can also be used for severe High BP due to kidney problem **Side note: if BP fluctuates drastically - it is caused by the kidneys and not associated with arteriosclerosis

Small Compressed Pulse



3 Types of Kidney related HBP1. Kidney stones - Dissolve (KS)

If Kidney Cyst (pulse will be larger than pen-tip): Add Hot or Cold Breaker if there is a cyst in the kidney - Hot Breaker – Huai Hua, Xuan Shen, Xia Ku Cao, Zhe Bei Mu - Cold Breaker – San Leng, E Zhu, Wang Bu Liu Xing

2. Water metabolism kidney issue with high blood pressure; Blockage in ureter Shui Ding Xian - 20 Dan Shen - 20 Xian Feng Cao - 20 Di Long - 20 Li Zhi He - 20

3. Kidney yang deficiency (weak kidney and bladder function) – cold condition - EGFR – filtration rate of kidney is low. - Use Yin Yang Huo 55% + Xian Mao 25% + Si Ni Tang 20%



Large Compressed Pulse

Large Compressed Pulse Large - Extended Compressed Pulse



The larger compressed pulses that occur with the Excess Heat (inflammation) pulse in the Chi positions, represent active inflammation and pain. The harder compressed pulses that occur without the Excess Heat (inflammation) pulse represent a more chronic condition of tissue damage with restricted circulation.

- In male patients, the bilateral presentation of medium or large compressed pulses in both Chi positions can represent prostate issues, such as Benign Prostate Hyperplasia, Prostatitis, and Prostate Cancer.

Large Compressed Pulse Indications: - Shoulder pain, stiffness from soft tissue damage Large-Extended Compressed Pulse Indications: - Bone spurs, disk problems in the neck and shoulders, neck pain, thoracic inflammation




Herbal Treatment: - Inflammatory soft-tissue damage: Astringent Complex 60%, Zhen Ren Huo Ming Yin 25%, Ge Gen Tang 15% (channel guiding formula)

- Chronic Issue: Add more blood movers Other than Circulation SJ what else can be used? - Shen Tong Zhu Yu Tang (frozen shoulder with blood stasis - Shu Jing Huo Xue Tang (blood stasis and damp) - Bu Yuan Huan Wu Tang (frozen shoulder with Qi deficiency and blood stasis) - Er Zhu Tang if frozen shoulder with damp

- Bone spurs or disk problems: Flex Spur

- Prostate enlargement (Bilateral Large Compressed Pulse): Resolve (Lower) 50%, Astringent Complex 50%




Headache / Migraines caused by Cervical referral:

Chuan Xiong Cha Tiao San – 30 Seattle 1 Complex – 30 Ge Gen Tang – 20 Flex Spur – 20




Blocked (Stage 1-3) PulseBlood Stasis (Circulatory Occlusion) & Dampness (Fluid Retention)

Indications: - Frozen shoulder - Past traumatic injuries with chronic blood stasis - May also experience numbness of the arm and fingers due to shoulder circulatory obstruction



Herbal Treatment: Frozen shoulder, dead blood causing upper body pain: - Circulation SJ - 30 - Ge Gen Tang - 20 - Er Zhu Tang - 50

If no hypertension can use - Bu Yang Huan Wu Tang – 80 - Ru Xiang – 10 - Mo Yao – 10

Traumatic injuries - Circulation SJ 40 - Ge Gen Tang 30 - Flex (Spur) 30

Blocked (Stage 1-3) Pulse



Right Proximal Position

1. High - Forceful - Thick - Wiry (Extends proximally) 2. High - Forceful - Slightly Thick or Thin - Wiry

(Extends proximally)



High - Forceful - Thick - Wiry (Extends proximally)



Indications:

- In the R Chi and extends - Urinary dysfunction - UTI, burning urination, KD infection.

- In the L Chi and extends in females with very hot hands - hormonal imbalance - excess estrogen.

- In bilateral Chi positions - chemical poisoning, environmental toxins, heavy metal poisons, multi-chemical sensitivities. - Exposure to chemical fumes, agent orange, glue, gasoline, paint, gun powder, etc.

High - Forceful - Thick - Wiry (Extends proximally)



Herbal treatment: Chemical poisoning or sensitivities: - Ba Zheng San - 40 - Long Dan Xie Gan Tang - 20 - Herbal ABX - 40

Urinary dysfunctions due to heat: - Ba Zheng San - 40 - Herbal ABX - 60

Hormonal imbalance/conditions with heat s/s - Shan Yao - 30 - Zhi Bai Di Huang Wan - 20 - Seattle 1 Complex - 50

High - Forceful - Thick - Wiry (Extends proximally)Hormonal imbalance/conditions with cold s/s - Shan Yao - 50 - You Gui Wan - 20 - Bu Gu Zhi - 15 - Jiu Cai Zi - 15

Salty warm and bitter warm herbs are good to tonify hormones i.e., Bu Gu Zhi, Jui Cai Zi



High - Forceful - Slightly Thick or Thin - Wiry (Extends proximally)

Indications: - Neck pain, stiffness - Upper body aches and pain



Herbal Treatment:

Neck pain: - Seattle 1 30 (inflammation), Astringent Complex (inflammation), Ge Gen Tang 20 (guide), Flex Spur 20 (pain)

Upper body pain/joint pain with flu (wind-cold): - Ji Xiang Teng - 50 - Dao Di Wu Gong - 50




Migraine/Chronic Headaches:

- Chuan Xiong Cha Tiao San - 30 - Gardenia Complex - 30 - Ge Gen Tang - 20 - Flex Spur - 20




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