AdvancedPulseDiagnosis

JamesRamholz
Inrelationtothehumanbody,yangisabovethemiddle andontheback;yinisbelowthemiddleandonthefront. Theeversionofaspherehelpsillustratesthe internal/externaldivisionandtransformationofyinand yang.Theexteriorsurfaceofthesphereisyang,andthe interiorsurfaceisyin.Theinteriorpurpleandexterior goldsurfacesofthespherechangeplacesin4dimensional space/time.Thetransformationstartsatthetopleftcorner andmovesclockwise.Inthisprocess,yangandyinchange placeusingthemostnaturalwayand,therefore,theleast amountofenergy.Theeversionofasphereisa4 dimensionalTaiji diagram. Whentheprocessgetstothemidpoint[lowerright corner],thefigurecanbedividedincrosssectiontoreveal theBagua,anoctagonoreightsidedfigure.ThattheBagua liesatthemidpointonthemoststablepathwaythrough thisprocessunderscoresitsimportanceinChinesetheory andmedicine.

Copyright2002,2003byJamesRamholz

TableofContents
TheNormalPulseWave 3 4 5 BasicPulseWaveDynamics TheNormalPulsein3D TheNormalPulseinCrosssection BasicPulseQualities 15 16 17 18 19 20 21 22 FloatingandSinking FastandSlow SlipperyandChoppy LongandShort WiryandSoft KnottingintheClassicalFashion DongHanDevelopments,III: CancerMovement Picture:JiangJingExplainingSome DetailsoftheBreastCancerPulseat NYCSeminar

NormalPulsePositions 6 7 8 9 10 11 12 13 TheImportanceofLocation 1and2LongitudinalDepths 3LongitudinalDepths InteriorandExteriorPerspectives MoreonOrgansandChannels DongHanDevelopments,I: 9sectorsModel DongHanDevelopments,II: 27sectorsModel 5LongitudinalDepths

BasicPulseWaveDynamics
ThegeometryoftheNormalwaveform
TheNormalpulse(Zhengchangmai) isrecognizedby itsuniquesymmetryanduniformrelationto breathing2beatsontheinhaleand2ontheexhale. Inyin/yangtheory(base2),aNormalwaveisdefined astheselfelementofaposition(wiryforWood,etc.) plusstomachqi.Intermsof5Phases(base5),the risingandspreadingmovementisWood;thecresting movementorexpandingoutwardfromapointisFire; thedescendingmovementisMetal;andthetroughor crystallizingtoasinglepointmovementisWater. Earthcanbeconsideredeitherthelast18o ofeach,or thesubstantialness ofthewholewave. Thetopfigureshowsthewavemovementintime, movinglefttoright.Thebottomfigureshowsthe waveexpressedinitsenergeticorstatespace.Instead ofcontinuingalongthetimeline(Xaxis)asinthetop picture,thewavecompleteseachcyclebyreturning. Allenergeticvaluesandpossibilitiescanbeillustrated init.
a

Y-axis b c a
c

X-axis d
d

Yin of Yang

yang of Yang

yin of Yin

yang of Yin

BasicPulseWaveDynamics
TheRelationofStateorPhaseSpacetoTime

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Intheseriesoffiguresontheleftside,therotation alongthecircleismappedtothetimeline.The figureaboveshowsthecompletedcycle.Then,the

2. 4. 6.

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seriesrepeatsitselfagainwiththesequenceonthe left.Allenergeticvaluesandpossibilitiescanbe diagramedinthisstatespacetoillustratethe qualitiesofeachpulseposition.

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BasicPulseDynamics
3dimensionsandrotationalaspectofthebasicpulsewave

Thepulsewaveineachpositioncanbe describedin3dimensions. TheXaxisisrelatedtothelengthalongthe arteryandtime(frequency).TheYaxisis relatedtodepth(amplitude).TheZaxisis relatedtothewidthofthepulse,andthe position positionsoverallcapacitywhenconsidered withtheamplitude.Therotationalforceofthe movementiscalledthetorque. Y AstheNormalpulsemovesforwardalongthe XaxisfromProximaltoDistal,itcanalsorotate clockwise,expressing6 6Qiqualitiesincross section. X Z

Consideredtogether,thelongitudinaland rotationalmovementsexpresshow5Phases and6Qiareinterrelatedandmutually engendering.

NormalPulse
3DCrosssectioninYin/Yangand5Phases

Pulsescanexpressbothayin/yang(inner/outer)or a5Phasecrosssectionrelatingtotheirassociated qualities. Forexample,theHolloworOnionStalk(Kou) pulse takesitsnameandshapefromthecontrastofthe emptyyinorinnerportion portionKidney,Liverand Spleencore coretotheouterportions.Itindicates blooddepletion. Classicallydescribed,whenpressingdownfrom skintobone(alongtheYaxis),tensioncanbefeltat thesurface,thensoftnessoremptinessattheblood depth,andthentensionagaininthedeeperpart. Whenyoursensitivityisstrongeryoucanalsofeel thewalloftheOnionStalkcharacteralongthe outeredgesorthirddimension.

Kidney Liver Spleen Heart Lung

TheImportanceofPulsePositionsand PhysicalLocationstotheQualities

Space,Time,andQualitiesareinseparableaspectsofthediagnostic informationfromthepulses.

AsitsaysintheNanJing, Ineachcase,onedeterminesonthebasisofthe locationofthemovementsintheconduitswhethertheinfluencesincaseofan illnessproceedcontraryto1 orinaccordancewith2 theirpropercourse.

Unschuldtranslation,Difficulty4

1.Ni,counterflow 2.Zheng,correct

OneandTwoDepths
Zang and Fu

Fromskintobone,
eachpositioncanbeseenasasinglespace associatedwiththezang organofthat position;oritcanbedividedinto2depths, relatedtoboththezang andfu. TheZang andFu refertothesolidand holloworgans,respectively.Theyreflect thestorageandtransformativecapacityof thePhaseassociatedwiththatposition. Likeallotherpulsemodels,eachdepthcan beviewedincombinationwithanotherto describeasinglemovement,orasdifferent sectorsorspaceswiththeirownseparate movements,qualities,anddiagnostic information.

Proximal Fu
Hollow organs

Middle

Distal

Zang

Solid organs

3Depths
FromtheNanJingand MaiJing

Fromskintobone,
eachpulsepositioncanbedivided into3depths:qi,blood,and adapteddepth(inotherpulse systems,thisisreferredtoasthe organdepth).Thismodelreflects bothchannelandorganinfluences. Thedistalpositioncanreflectthe bodyfromtheheadtothe diaphragm;themiddleposition fromthediaphragmtothenavelor groin;andtheproximalposition fromthenavelorgrointothefeet.
Qi Skin, meridians, emotions Blood Current physiological processes Adapted Organs and deeper or habituated patterns

Proximal

Middle

Distal

InteriorandExteriorPerspectives

Upperback

ChestorFront

Skin
Middleofback

Surface
Diaphragmline

Bone

Bone

Abdomen Lowerback
Navelline

LowerAbdomen

MoreonChannelsandOrgans
NanJing Difficulty18

The3DepthModel,seenearlier,presentsthebasis foracombinedchannelandorganpulse perspective.NanJing, Difficulty18,further examinesthepulsepositionsfrombothanorgan andchannelperspective. Thisperspectiveshowsthebasic5Phase networkingandconnectionbetweenthepositions fortheorgans. Butbecausemostchannelstransversetheentire body,thisperspectivedoesnotrevealthecorrect channelsymmetry,flow,andconnectionbetween positions. ThisproblemwassolvedintheDongHansystem. LikeaChinesepuzzle,thechannelsymmetryand interactionsareonlyrevealedwhenexaminingthe pulsesatadifferentscale.

Heart Shaoyin Liver Tzuyin Kidney Shaoyin

Lung Taiyin Spleen Taiyin San Jiao Shaoyang

Creation (Sheng) Cycle Control (Ke) Cycle

Moreabout3DepthsModel
DongHanDevelopment,V
IntheDongHansystem,weoftenexaminethe Proximal
Qi Skin, meridians, emotions Blood Current physiologic al processes Adapted Organs and deeper or habituated patterns

Middle

Distal

qualitiesofseveraldifferentcombinedpositions, sectors,ordepthsinordertointerpretthingsnot previouslyaccountedforinclassicalpulsediagnosis. ManyideasfromWesternmedicinecanbefoundin thistypeoforganization. Movementsonthedividinglinebetweentheqiand blooddepthsoftenrelatetothesensorylevel[yellow dottedline].Problemsrelatedtothesensorysystem associatedwithaparticularorgancanoftenbefound here.Forexample,earsinthekidneyposition,etc.

Movementsonthedividinglinebetweenthebloodand adapteddepthsoftenrelatetotheendocrinelevel[red dottedline].Problemsrelatedtotheendocrinesystem associatedwithaparticularorgancanoftenbefound here.Forexample,adrenalsinthekidneyposition,etc.

DongHanDevelopment,I
BasedonNanJing Difficulty18
Proximal

Middle

Distal

IntheDongHansystem,eachpulseposition issubdividedintoasmallerscalefractal imageofall3jiaos. Inthisway,thewhole bodycanbeexaminedfromtheperspective ofeachrespectiveorganorphase.For example,ifthisistherightwrist,thenweare examiningtheuppermiddleandlowerjiao fromtheperspectiveoftheEarthphase.

Whendividedapositionfromskintobone into3depths,wecreate9sectorsineach.

Wecanevenfirstdividethepositioninto zang andfubeforedividingitinto3depths; inwhichcaseeachdepthhasitsown9 sectors.Doingso,wecanexaminethe relationofeitherorboththespleenor stomachchannelstothewholebodyinall threejiaos.

DongHanDevelopment,II
MoreonNanJing Difficulty18

Wecangostillanotherstepfurtherthanour

previousdevelopmentontheNanJing.When includingthe3rddimension,thewidthofthe artery,the9sectorsmodeldevelopsintoa27 sectorsmodel.Inthiswaywecanseebothleft andrightsidesofthebodyononewrist. Wecanalsofirstdivideeachpositionupinto zang andfu beforeexaminingbothdepthsin termsof27sectors.Thisisabasicunit inthe DongHansystem,anditcanbeinterpretedin severaldifferentways.

Proximal

Middle

Distal

Later,wewillcontinuetodivideeachposition

inavarietyofotherways,too.Aslongasweare consistentwiththeoryandcandemonstrate clinicaleffectiveness,allofthesepulsemodels willbeanimportantandusefuldevelopmentof classicaltheory.

FiveDepths
NanJingDifficulty5

Fromskintobone,eachpulsepositioncanbedivided into5depths. Thispulsemodelisnotalwaysstrictlyrelatedto channelandorganinfluences.Instead,each depthisrelatedtothetypesoftissueassociated withtheLung,Heart,Spleen,Liver,andKidney: skin,capillaries,connectivetissue,muscles,and bonerespectively. Thisisthefirstpulsemodelthatdramatically changesourdiagnosticperspective.Usingit,we canexaminehighlylocalizedandevenisolated problems;notsimplyrelategeneralinformation abouttheposition. Eachofthese5depthscanbelookedatin combinationwithotherstodescribeasingle movement,sometimesacrossseveralpositions. Theycanalsobeseenasindividualsectorsor separatespaceswiththeirownwavesqualities andinformation.

Proximal Lung

Middle

Distal

Heart

Spleen

Liver

Kidney

ChoosingaParticularPulseModel

Withthewidevarietyofpulsemodelspossible,thequestionarisesasto whichdoesapractitionerchoosetoapplyoneoranother? Itisnotamatterofchoiceforthepractitioner.Thepatientwillalreadyhave chosen orpresentedtheirproblemintheirownway.Thatiswhythe varietyofpulsemodelsexistsinthefirstplace.

BasicPulseQualities
SymmetryBreakingoftheNormalPulse
TheNormalpulse(Zhengchangmai) is recognizedbyitsuniquesymmetryand uniformrelationtobreathingtwobeatsonthe inhaleandtwoontheexhale.Thisreflectsthe respiratoryandcardiovascularcirculationsqi andbloodmovingandworkinginharmony. Allotherpulsequalities,theircombinations, andtheirdiagnosticmeaningsarederivedfrom thebreakdowninsymmetryoftheNormal pulse. yang of Yang createdtheOne,OnecreatedTwo,andTwo createdmyriadthings. yang of Yin d yin of Yin a IntheDaoDeJing,LaoTzusaysthattheDao b Yin of Yang a d Y-axis c X-axis b

FloatingandSinkingQualities
FloatingandSinkingrefertothemost superficialandgreatestdepthatwhichyou findthepulsemovement.AFloatingpulseis feltassoonasthefingerstouchtheskin,but disappearswhenfurtherpressureisapplied. ASinkingpulsefeelsdistinctonlyatthedeep level.ASunkenpulseisessentiallyassociated withinteriorpatterns,althoughtheexterior patternsofexternaldiseasesmaytemporarily presentwithatightSunkenpulsewhenthe bodysyangqiisobstructed.

SlowandFastQualities
ASlowpulsehas3orfewerbeatsperrespiration. TheSlowpulseisprincipallyassociatedwithcold andyangvacuity.Itmayoccurinanydisease involvinginsufficiencyofyangqiorobstructionof qimovement,suchascold,phlegmturbidity,and staticblood. ARapidpulsehasmorethan4beatsperrespiration. Onehavingbetween5and6beatsistermeda slightlyRapid;morethan6beatsisveryRapid.The Rapidpulseisassociatedwithheatbutmay, sometimes,beanindicationofdepletion.Aforceless fineRapidpulseindicatesyinvacuityfireeffulgence andisgenerallyseenindepletionpatterns.A forcefulRapidpulseindicatesrepletionheatandis mostcommonlyseeninfebrilediseases.

SlipperyandChoppyQualities
ASlipperypulsefoundsystemwideisusually indicativeofexcessqiinthebody.Itdoesnot necessarilyindicatethatthemucusisstagnating andformingblockagesbutratherthatthebody isintheprocessofsecretingit.Itisalso sometimesseeninhealthypeople,indicatingan abundanceofqiandblood. AChoppypulsedoesnotflowsmoothlyandis classicallydescribedasaknifescraping bamboo. Theroughpulseisoftenseeninblood stasispatternsanddualvacuityofbloodandqi.

LongandShortQualities
AShortpulsedoesnotlongitudinallyfillits position.Itwillnotlastlongsinceitdoesnothave enoughsupporttocreatethatenergymuchlonger; oritcanindicatealocalizedproblem.The movementisbecomingmoreyin. ALongpulseisamovementthatextendsbeyondits ownposition.Themovementisbecomingmore yang.Itisoftenseenwhenonepositionissending itsinfluencetoanotherpositionalongtheSheng cycle. LongandLarge(alongtheverticaldimension)are yangincomparisontoShortandSmall.Largeand Smallgenerallyindicateqioryangqualities,while LongandShortindicatebloodoryinqualities.Soa Largepulseisyangofyang,aSmallpulseisyinof yang,aLongpulseisyangofyin,andShortpulseis yinofyin.

WiryandSoftQualities
AWirypulsefeelslikeastringofamusical instrument.Thestringlike pulseiscommonly associatedwithdiseasesoftheliverand gallbladder,andinparticularwithascendant hyperactivityofliveryang.Itisalsoassociated withneuromusculartension,pain,andphlegm rheumpatterns.TheWirypulseisgenerally strong.Butifforceless,itistermedavacuous stringlike pulse,indicatingthevacuityofyin andhyperactivityofyang. ASoftpulseiswithoutstrengthandindicates depletionoftheyinandbloodanddepletionof jing.

KnottingintheClassicalTradition
ThismovementisdescribedbyLiShizhen asonethat missesabeatatirregularintervals.Itisanirregular pulsationindicativeofenergyblockagesandaggregation ofyinsuchasseeninphlegmblockages,tumors,cancer, orbloodclots.

CancerMovement
DongHanDevelopment,III

ThestandarddefinitionofKnotting(jie) inTCMisonethatmissesabeatat irregularintervals.

IntheDongHansystem,thistermismodernizedto includeamovementthatseemstobecresting,flattening, andstopping.Butevenwhileitisstoppingorflattening atthecrestthereisstillsomemovementgoingoninside it.Sometimeswhenthepulserisestothetopofitsarch youcanfeelavibratoryqualitywithoutanydescending motion.Itmayalsofeellikeasmalltornadoonitsside; whatwenicknamedspinners. Thisvibratingor spinningqualityindicatesthattheenergyis concentratingandcreatinganaggregation,andcanbe interpretedinseveralways.IfthemovementKnots irregularly,youcansuspectacystorhematoma.Butifit Knotswitheachbeat,youshouldsuspectcancer.

JiangJing
BreastCancerSeminarinNYC Inthediscussionof acasestudyduring theBreastCancer seminarinNYC, notetheDongHan styledrawingsof theKnottingpulse movementsonthe whiteboard.