HerbalThink-TCM Beginner Tutorial #5:
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Tutorial #5: TCM Pulse Simulator
This tutorial may be completed using only the Test option of HerbalThink-TCM. However, the Pro option will enable you to understand many of the fine points of pulse palpation by controlling and combining individual parameters to produce over 900 million specific variations of pulses intended to span the full range of pulses that one might realistically encounter.
Pulse palpation is ideally learned by doing all the following:
============ HERBALTHINK-TCM BEGINNER TUTORIAL #5 QUESTIONNAIRE ========== (updated 2017-02-10) --------------- TCM Pulse Simulator, control buttons: A-0: For a normal pulse, at which depth would you feel it most strongly? [ ] A-1: What is the 'length/duration' of a pulse? (See tooltip.) [ ] --------------- Pulse rate, rhythm, and duration: B-0: As the pulse becomes more rapid, what happens to the normally quiet inter-pulse interval (when the pulse is at its low point at the diastolic pressure)? [ ] B-1: Some classical texts refer to a pulse with a very short length/duration to be like what action of which animal? (See tooltip.) [ ] --------------- Pulse depth and depth-spread: C-0: For a sinking pulse, at which depth is it strongest? [ ] C-1: For a floating pulse, at which depth is it strongest? [ ] C-2: When estimating the depth-spread of a client's pulse, what criterion is always important to keep in mind? (See tooltip.) [ ] C-3: A weak pulse will naturally tend to be felt only within a narrow depth range; does this imply that most weak pulses should be considered 'compressed'? If not, what is the correct criteria? [ ] --------------- Pulse strength and elasticity: D-0: Is it possible for a pulse to be simultaneously strong and loose, or weak and taut, at the same time? [ ] D-1: How common are the preceding combinations? [ ] --------------- Pulse width and edge: E-0: A weak pulse is naturally smaller in dimension on an absolute scale. Does this mean that most weak pulses should be classified as being narrow? If not, what is the correct criteria? [ ] E-1: List two examples of traditional/classical pulses that have a fuzzy edge. [ ] E-2: List two examples of traditional/classical pulses that have a distinct edge. [ ] --------------- Pulse profile: F-0: A noisy pulse may be easily confused with what other type of pulse? (See tooltip.) [ ] F-1 (Pro only): Simulate a pulse that is simultaneously smooth and noisy. How does this pulse compare with a pulse that is just noisy? [ ] =============================== END ======================================
TCM Pulse Simulator, control buttons
On the HerbalThinkTCM control panel, click the TCM Pulse Simulator button. In the Test option, the individual parameter controls on the left will be grayed out except for the Traditional control; these are all accessible only in the Pro option. However, all other controls shown below are functional, and the tooltips for each parameter are accessible in all version-options.
What you are looking at in this portrayal of a normal pulse are three different sets of perspectives, which in total will indicate exactly what is happening in 3 dimensions and time:
Hover your mouse over the Rate label for a second, and a tooltip will appear as follows:
Each of the 12 parameter labels has a corresponding tooltip that will give you a concise reminder of what that parameter means and key aspects to observe when you are feeling a real pulse. For the rate, it is as simple as counting beats per minute with a stopwatch and then noting the correct slow/rapid categorization.
Along the top right of the TCM Pulse Simulator window, there is a series of control buttons whose function will be obvious when you try each of them. For the purposes of this tutorial, the most important control buttons are near the center of the display, just to the left of the fingernail. These are the depth controls, which represent finger depth while palpating the radial pulse near the wrist:
At this time, click on the Traditional control popup button at the bottom of the left-side set of parameter controls. Change the value to normal (which should be the 2nd choice available in the list). Then try clicking on each of the depth controls and observe how the display changes to indicate what the palpated sensation would be at each depth note how the set of three time profiles displayed at the bottom changes to highlight the currently active depth-tracing in bright orange:
Questionnaire TCM Pulse Simulator, control buttons
Instructions for using the Test option to complete this tutorial
The Test option provides you with access to simulating all 28 classical pulse types as taught at many colleges of traditional Chinese medicine. However, as we explain here and in our courses, this is not an ideal way to learn and presents the student with a number of severe challenges and logical dilemmas. The most severe dilemma is the following: Li Shi Zhen's classic text on the pulse defines the 28 classical pulse archetypes in very much the same way that we do, based on combinations of fundamental physical parameters like rate, rhythm, depth, etc. However, in real life, a given pulse will very rarely match a classical archetype exactly. With 12 distinct pulse parameters and anywhere from 4 to 10 possible values for each parameter, there are almost 1 billion different possibilities! It is absurd to think that one can achieve sophistication by merely stating which classical pulse archetypes match the present case. It will always be more accurate to explicitly specify each parameter value as it occurs in the real patient's pulse, not in some idealized textbook example.
The method that we teach in all of our courses is to require students and practitioners to focus on a single parameter at a time, determining which value most closely describes what he or she actually feels in the someone's pulse. Write it down, then focus on the next parameter, etc. At the end, you will obtain a description that will likely not match any classical archetype perfectly. However, if it comes close in certain aspects to some archetypal pulse, that archetype may have some relevance toward suggesting certain diagnostic possibilities. With the Pro option of this software, one can dial in each of the 12 parameters to match a given individual's pulse and obtain an overall simulation that very closely matches what is actually felt. The accuracy, precision, and consistency that can be achieved with this method is obvious.
Throughout the remainder of this tutorial, if you are working with the Test option, follow the Test-specific instructions that appear within each section. The classical pulse archetypes that exemplify different values of a specific parameter will be listed. Try selecting each example, and note how different values of the parameter affect the pulse strength, rhythm, shape, width, time profile, and other qualities.
Within the Traditional popup control, the classical pulse archetypes are listed in the following order:
Pulse rate, rhythm, and duration
The first three parameters, rate, rhythm, and duration, are independent of position. No matter where in the body you feel a pulse, these characteristics will be the same. In traditional pulse palpation, we typically observe the pulse qualities at three positions at both the left and right radial arteries at the wrist, noting the individual characteristics at each position. However, the rate, rhythm, and duration are specified only once, because these are the same everywhere.
Click on the Rate popup control and select each option in sequence, from very slow to very rapid. The 'shorthand' convention for parameter values that we use throughout the TCM Pulse Simulator is as follows:
For Test option, see traditional pulse types: slow, rapid, racing.
In most cases, an 'extreme' value for a specific parameter would be considered as any value that is beyond the range of what can be visually simulated in this software. The parameter control choices here generally range between very X and very Y.
Reset the Rate to Ø (normal) . Now try out the various Rhythm possibilities. Note the differences between regularly-irregular pulses, in which the rhythm is very regular, but skips a beat every Nth beat, and irregularly-irregular pulses for which the rhythm is always somewhat random.
For Test option, see traditional pulse types: intermittent.
Reset the Rhythm to Ø , and try choosing various values of Length/duration, from very short to very long. The duration of the active phase of the pulse is closely related to how prolonged is the physical contraction of the heart.
For Test option, see traditional pulse types: short, long.
Now practice feeling these qualities on real people. Practice correct posture and positioning of your fingertips over the radial artery at the left and right wrist. Use a stopwatch to count beats per minute, then convert this number to a slow/rapid categorization after referring to the rate tooltip. Observe rhythm. Rhythm irregularities will tend to be rare unless the individual is suffering from some type of heart disease or is under extreme stress. Mild, occasional rhythm irregularities, however, are common and occur even in relatively healthy people. Abnormal length/duration also tends to occur more rarely, also in people with heart disease and/or severe stress on their circulatory system that causes the heart either to work much harder or else is in the process of exhausting it.
Questionnaire Pulse rate, rhythm, and duration
Pulse depth and depth-spread
Reset any previously set controls to Ø (normal). Hint: if you have changed several, you can reset them all to Ø by selecting normal from the Traditional control (normal is the 2nd item in that list).
Try the various settings of the Depth and Depth-spread controls, and observe how these affect the pulse quality. Note especially the differences among the three time-profile waveforms.
Note: regarding Depth vs. Depth-spread, the 'hollow' quality should logically be considered the opposite of 'compressed' and should appear in the Depth-spread control. However, to make the display controls consistent, we had to place the 'hollow' options inside the Depth control.
For Test option, see traditional pulse types: sinking, floating.
For Test option, see traditional multi-parameter pulse types that specify depth-spread: leek-stalk, drumskin.
Questionnaire Pulse depth and depth-spread
Pulse strength and elasticity
Try the various settings of the Strength and Elasticity controls, and observe how these affect the pulse quality. Read the tooltips for each of these parameters.
Note: regarding Elasticity, it was challenging to design a video icon that would represent tautness/rigidity in the pulse. What we came up with is an icon that seems to "fight back" by strongly pushing into the palpating finger. Looseness, its opposite, is represent by a video icon that is easily pushed around by the palpating finger, as a water-balloon might feel.
Elasticity is closely related to the diastolic pressure of the pulse, its lowest value during each pulse cycle. Consider an automobile tire that is low on pressure; when kicking such a tire, it will feel spongy and soft, whereas a properly inflated tire will have a tighter quality. Arteries behave similarly. The perceived strength of a pulse is closely related to the difference between the systolic (maximum) and the diastolic (minimum) pressure, which is represented by the amplitude of the time-profile waveform.
For Test option, see traditional pulse types: faint, weakened, strong.
For Test option, see traditional multi-parameter pulse types that specify elasticity: dispersed, bowstring, confined, tight, drumskin.
Questionnaire Pulse strength and elasticity
Pulse width and edge
Try the various settings of the Width and Edge controls, and observe how these affect the pulse quality. Read the tooltips for each of these parameters.
If a pulse edge is fuzzy, the left and right edges will taper off gradually it is difficult to judge the exact boundary, and such a pulse will feel somewhat like a cotton ball at its edges. In contrast, a distinct-edged pulse has a very clear, sharp boundary and its left/right edges taper off abruptly.
For Test option, see traditional multi-parameter pulse types that specify width: soggy, infirm, small, leek-stalk, thready, slippery, mobile, bowstring, confined, large, tidal.
For Test option, see traditional multi-parameter pulse types that specify edge: soggy, infirm, small, soft, thready, languid, slippery, mobile, confined, bowstring, tight, drumskin, knotted.
Questionnaire Pulse width and edge
Try the various settings of the Smoothness, Noisiness, and Abruptness controls, and observe how these affect the pulse time-profile quality. Read the tooltips for each of these parameters.
For Test option, see traditional multi-parameter pulse types that specify smoothness: languid, slippery, mobile, knotted.
For Test option, see traditional multi-parameter pulse types that specify noisiness: choppy.
For Test option, see traditional multi-parameter pulse types that specify abruptness: tidal.
Questionnaire Pulse profile
Summary of what you learned in this tutorial
The pulse palpation methods of traditional Chinese medicine are reputed to take many years of study. Confusing terminology and a lack of systematic procedures has made it unnecessarily difficult. The pulse palpation method you have been introduced to here is not only much more accurate, it is also easier and much quicker to learn. To obtain thorough and accurate descriptions of the pulses at each of 6 standard positions at left and right wrist: