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— updated 2017-07-26

HerbalThink-TCM — Herbalists' Bootcamp
Beginner Tutorial #5:   TCM Pulse Simulator

by Roger W. Wicke, Ph.D.
This tutorial series will help you get started using the HerbalThink-TCM software, ensure it is installed correctly, and demonstrate how to use important features and modules.

Copyright ©2016-2017 by RMH-Publications Trust; all rights reserved. Published by the Rocky Mountain Herbal Institute; c/o PO Box 579; Hot Springs, Montana [59845] USA. Education and software for health professionals:   www.rmhiherbal.org


Jump to another tutorial in this sequence:
#1: Download #2: Setup and Documentation #3: Self-Study Reference #4: TCM Herbal Tutor #5: TCM Pulse Simulator #6: CaseQuery and AutoSage-TCM #7: Completing member/admission requirements

Subtopics on this page…

 

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:

  • Reading. TCHS Vol.1, Ch.15 ("Pulse palpation") — accessible in the Basic and Pro options of HerbalThink-TCM.
  • Video simulations. Using TCM Pulse Simulator as a visual guide to understand each parameter — the fully functional TCM Pulse Simulator module is accessible only from the Pro option.
  • In-person classes. Have an RMHI-authorized Group Leader in your area, who has the Pro option and has practiced this method for at least several months, personally give you a class in this subject.
  • Correct position and posture. For beginners, the most important detail to get right initially is to start out taking pulses at the correct positions on each wrist. (See footnote •[1]•)   This is explained in TCHS Vol.1 Ch.15. Next, it is important for you and your client to relax and for you to have good posture and body positioning with respect to your client. If your arm and wrist are tense or positioned at awkward angles, this can impede circulation in your fingertips and will diminish sensitivity.
  • Practice frequently. Too many people have heard, incorrectly, that learning pulses is difficult, confusing, and arduous, so they never even try. You may be surprised to discover how much you can learn, even with the limited Test option. As you practice taking people's pulses, the sensitivity and awareness in your fingertips will increase, so don't worry about getting all the fine details correct at the beginning.




 

Questionnaire #5

  • All questions below can be completed with access to the 'Test' option of HerbalThink-TCM.
  • Copy and paste the following into a text document using any simple text editor (Mac OS X: TextEdit;   Windows: WordPad, Notepad). You will be filling in your answers (between the [ ] marks) during this tutorial and then emailing your completed questionnaire to your assigned tutor.
  • Most questions will require simple, short answers. These questions are designed primarily to ensure that you know how to access the appropriate Pulse Simulator controls and are interpreting its features correctly.
  • Now you are ready to actually begin the tutorial. Follow the instructions in the remainder of this tutorial, and then fill in your answers to the questionnaire when asked to do so.
  • Please submit this tutorial questionnaire and wait for a reply/feedback from RMHI before continuing with the next tutorial.
============ HERBALTHINK-TCM BEGINNER TUTORIAL #5, QUESTIONNAIRE ==========
                             [updated 2017-07-26]

YOUR FULL NAME:  [  ]

--------------- 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:

  • Animated pulse icon. The animated pulse shown beneath the finger is a video icon intended to represent the tactile sensation that the pulse would induce when palpated, not what it actually looks like. If you change the depth controls for the pulse icon, you should see the finger position shift up/down and the pulse icon change to match exactly how it would feel at each depth.
  • Time profiles. The three sets of waveforms at the bottom represent the pulse pressure as it changes over time, at the superficial, middle, and deep levels. The time profile that is highlighted in bright orange corresponds to the current depth-position of the palpating finger displayed in the animation.
  • Width profile snapshots. At the bottom left are a set of three pulse icons, which comprise a set of snapshots of the animated pulse icon as it appears at the peak of the pulse at each of the three depths. In this perspective, the palpated artery is extending perpendicularly into the computer screen, and left/right corresponds to the left/right edge of the artery.

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:

  • Superficial — palpating finger is resting lightly on the skin surface, with only slight pressure
  • Middle — moderate pressure is applied
  • Deep — heavier pressure is applied so that with just a bit of extra pressure your fingertip would be palpating the radius bone

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:

superficial :

 
middle :

 
deep :

 


 

Questionnaire — 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.)



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:

  • normal
Single-parameter pulses:
  • sinking
  • floating
  • slow
  • rapid
  • racing
  • faint
  • weakened
  • strong
  • short
  • long
Complex pulses of Deficiency type:
  • hidden
  • soggy
  • infirm
  • dispersed
  • small
  • soft
  • leekstalk
  • thready
Complex pulses of Excess type:
  • languid
  • slippery
  • mobile
  • choppy
  • bowstring
  • confined
  • tight
  • drumskin
  • large
  • tidal
Pulses with irregular rhythms:
  • intermittent
  • knotted
  • agitated



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:

  • SLOW!! — extremely slow
  • SLOW — very slow
  • Slow — moderately slow
  • slow — slightly slow
  • Ø — normal
  • rapid — slightly rapid
  • Rapid — moderately rapid
  • RAPID — very rapid
  • RAPID!! — extremely rapid
For Test option, see traditional pulse types:   slow, rapid, racing.
Multi-parameter pulses that also specify rate:   languid, mobile, knotted, agitated.

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.
Multi-parameter pulses that also specify rhythm:   knotted, agitated.

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.
Multi-parameter pulses that also specify length/duration:   soggy, small, leekstalk, confined, large, tidal.

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

  • 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

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.
Multi-parameter pulses that also specify depth:   hidden, soggy, dispersed, soft, leek-stalk, confined, drumskin.
For Test option, see traditional multi-parameter pulse types that specify depth-spread:   leek-stalk, drumskin.

 

Questionnaire — 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

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.
Multi-parameter pulses that also specify strength:   hidden, soggy, infirm, dispersed, small, soft, leekstalk, thready, languid, slippery, mobile, bowstring, confined, tight, drumskin, tidal, knotted.
For Test option, see traditional multi-parameter pulse types that specify elasticity:   dispersed, bowstring, confined, tight, drumskin.

 

Questionnaire — 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

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

  • 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-1: List two examples of traditional/classical pulses that have a distinct edge.



Pulse profile

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

  • 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?



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:

  • At each position, focus your attention on a single parameter at a time. Accurately describe each parameter value and write it down.
  • Refer to the tooltips for each parameter for important reminders about the proper criteria to keep in mind.
  • Optional:   Use the TCM Pulse Simulator (Pro option only) to create a visual simulation of the pulse that most closely matches what you feel.





Please submit your completed questionnaire for this tutorial, then
go to   Tutorial #6:   CaseQuery and AutoSage-TCM


Footnotes

  • [1]   [excerpted from TCHS Self-Study Reference, vol.1, The Language and Patterns of Life]   Placement of the fingers in a standard position is very important to obtain consistent readings. Traditionally, this is done by finding the styloid process of the radius, which can be palpated just proximal to the skin crease at the wrist. Once you have found the crest of the styloid process with your index finger, move this finger laterally until the pulse of the radial artery is clearly palpated, and then perhaps a bit distally – closer to the wrist. This is called the first position ("cun" or inch position), which lies in a fleshy hollow just proximal to the wrist which is usually bisected by a skin crease called the linea piscis. The second and third positions ("guan", or gate, and "chi", or root, positions) are then easily found by placing the third and fourth fingers adjacent to the index finger, each over the point where the radial artery can be felt most strongly. This method works well for clients who have approximately the same body size as yourself. For people who are significantly larger, you should space your fingers apart slightly, in proportion to their difference in size. For smaller people, you should palpate each position by alternately feeling the more closely spaced first, second and third positions with the index, third, and fourth fingers, respectively. In all cases, however, the index finger should be at a level with the styloid process, the other fingers positioned and spaced appropriately.