Pulse Diagnosis: Martha Lucas 2nd Ed.

Copyright 2019, 2nd edition
All rights reserved.
No part of this book may be reproduced in any form or by any

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Martha Lucas, Ph.D., L.Ac. Please respect this copyright.
Cover by Dancing Tornado Design

Pulse Diagnosis:
Beyond Slippery and Wiry
The Pulse Diagnosis: Biofeedback and Balancing System, taught

by Martha Lucas, Ph.D., L.Ac., is a practical and functional
system of pulse diagnosis that allows you to feel so much more in
the pulses than slippery and wiry! This diagnostic method gives
you feedback about the effectiveness of your treatment while you
are giving it thereby allowing you to see acupuncture work right
before your eyes.
You will experience enlightenment with every patient.
Written by
Martha Lucas, Ph.D., L.Ac.
Martha Lucas, Ph.D., L.Ac.
Pulse Diagnosis: Beyond Slippery and Wiry [ i ]
In My Master’s Footsteps
I am forever grateful to my pulse diagnosis mentor James
Ramholz, O.M.D. Jim was a very humble man and would never
have referred to himself as a Master. But I knew the genius and
commitment of the man and he was indeed a Master of pulse
diagnosis. He was my Master because his tutelage, encouragement,
and gentle nagging made me who I am in my practice of Traditional
Chinese medicine. Jim taught me to be a healer not just a
technician. And he taught me that it is my responsibility to be an
expert diagnostician so that I can better treat the causes of patients’
discomfort and disease.
Learn to become a healer .... not just a technician.

[ii ] Martha Lucas, Ph.D., L.Ac.
[iii ] Martha Lucas, Ph.D., L.Ac.
Contents
Chapter One
Pulse Diagnosis - Biofeedback and Balancing System: The
Key to the Successful Practice of Chinese Medicine - 1
Chapter Two
Looking at Different Models of Pulse Diagnosis - 21
Chapter Three
The Normal Pulse - 35
Chapter Four
A Short List of “Perverse” Pulse Qualities -
you won’t need many more than this - 49
Chapter Five
The Pulse Positions and/or Organ Locations - 69
Chapter Six
How to Take the Pulse - 89
Chapter Seven
Emotions Associated with the Organs and their
Energetic Signatures - 99
Chapter Eight
Point Combinations - 113
A Conversation with Huang Di - 123
Appendix - 129
References - 131
[iv ] Martha Lucas, Ph.D., L.Ac.
Pulse Diagnosis: Beyond Slippery and Wiry [ 1 ]
Chapter One
Pulse Diagnosis - Biofeedback and

Balancing System: The Key to the Successful
Practice of Traditional Chinese Medicine
Being an expert diagnostician is fundamental to being an effec-

tive practitioner. When you can properly read the pulses, you see a
rich, detailed, in-depth picture of the patient’s condition and his-
tory. In my private practice, I specialize in diagnosis and apply this
system every day with patients, yet I continue to learn because pulse
diagnosis is a living part of my practice of Chinese medicine. I was
very lucky to have a pulse diagnosis mentor, Jim Ramholz, O.M.D.,
whose interpretation of the classics, teachings, articles, clinical work,
and my work with him, continue to be the basis of my practice of
Chinese medicine. The human body and what pulse diagnosis tells
me about it continue to hold my wonder. My patients’ pulses teach
me something every day.
This book introduces you to the Pulse Diagnosis - Biofeedback

and Balancing System which will enable you to get much more infor-
mation from pulse examination than you do now. There is informa-
tion on fundamental and healthy pulse qualities, the significance of
pulse qualities in each pulse position according to this system, and
some treatment options based on this system. It is not only about
feeling the pulse but how to determine the effectiveness of your treat-
ment as you are giving it. It is an organized system that includes how
to speak with your patients about what is going on in their bodies,
what the causes of their symptoms are, how they can change things,
and more. Your patients will be excited about your new insight and
treatment effectiveness. In this book I am going to present what
some call “revolutionary” ideas about the pulses.
But for a few exceptions, pulse diagnosis is largely glossed

over in classes in Chinese medicine school; it is a lost art in the pro-
[ 2 ] Martha Lucas, Ph.D., L.Ac.
cess of revival. Coming out of school, I doubt all but a few graduates
can recognize the 27 Li Shi zhen pulse categories which is the most
basic system. Consequently, the role of pulse diagnosis in a school
clinic is very limited. Although the Nan Jing, Su Wen, and Mai Jing
have the foundations for some very sophisticated pulse models, by Li
Shi Zhen’s time, it is my impression that interest in the art of pulses
was already starting to wane. One problem is that we have too few
interested and qualified teachers. Or practitioners hear that in order
to be a good diagnostician you have to take the pulses for a long,
long time. Hardly anyone has the time or stamina of attention to
examine the patient’s pulses for an hour — let alone do it in a school
clinic setting (although you won’t have to do anything like that with
this system). In a school clinic there is not enough time for it to be
more than a confirmatory sign. Unless pulse diagnosis is taught well
and practiced from the beginning, maybe it should be reserved as a
specialty for the doctoral or postgraduate level. I haven’t studied the
basics for 15 years. So students sometimes have difficulty following
my ideas until we use them in the supervised practice part of my
internships and they need to apply them to a patient. I am fond of
often reminding them that nothing I know (or teach them) is on the
National Board exam but will most certainly show up in their pa-
tients every day.
Historically, the original acceptance and interest in Chinese

medicine was due to its effectiveness and exotic nature. I think that
its continuing acceptance and integration into Western culture will
depend, in part, on research to validate its effectiveness. People
who wouldn’t have originally tried Chinese medicine would do so
if there were studies supporting it and they didn’t like what modern
medicine was doing with their condition. But if we don’t design and
conduct our own type of research, we will be at the mercy of those
who do their own. In part, Chinese medicine is already being rele-
gated as a part of modern medicine. The canary in the coal mine has
died; the paradigm is shifting. Medical acupuncture is doing research
in biomedical terms and integrating Chinese medicine into modern
medicine, even in the ER. And, if you look at the trend in schools
and accreditation agencies, Chinese medicine is becoming increas-
ingly biomedical in character; it is fast becoming a subset of modern

Medicine using Chinese techniques. If we don’t want our version(s)
of Chinese medicine and pulse diagnosis to become marginalized, we
should do something persuasive, like conducting our own studies at
Chinese medicine colleges that demonstrate its effectiveness for dis-
eases and how it can complement modern medicine.We are way past
the time that students learning Chinese language will help save Chi-
nese medicine by translating unreliable or suspect Chinese research.
Our new motto should be Chinese medicine: made here in the USA.
So let’s revolutionize pulse diagnosis for the better! Pulse diag-

nosis is an art - the art of perception. With this system, you use the
pulses as a biofeedback mechanism in judging the effectiveness of
your treatment strategy, which is invaluable. You will see changes
as soon as the needles go in; you will see how your choice of points
is working - or not. It is a real-time system. A good examination of
the pulses can reveal the development of a condition before there are
any symptoms or signs. For example, we can see the development of
breast or prostate cancer months before the first physical sign or an
actual lump is found. That is one of the beauties of pulse diagnosis -
the body’s energy changes often precede physical changes. A model
like this will give you a much clearer picture of complex diseases like
cancer, emotional problems, and chronic illness. You will also see
that many conditions have their own characteristic patterns or what I
call signatures. Additionally, this system allows you to talk with your
patients about their real lives, their emotions, and their history, not
some esoteric idea. Using this system will put you in a much better
position than your professional peers who still might be misunder-
standing pulses, misdiagnosing, and even giving inappropriate treat-
ment. They’re not able to see the same richness that you will see.
We all know that there are a number of pulse diagnosis systems

or ideas out there each of them viewing the body and the internal
organs from a different perspective of structure and energy. In typ-
ical pulse diagnosis, everyone just uses the three jiaos. Advantage:
simplified, easy to learn quickly. Disadvantage: you don’t get much
information; it’s all generalized for each jiao. You don’t get specific;
you don’t see what’s going on differently at the surface from in the
interior; you don’t identify emotional stuff. Often, to gain a complete
picture of the patient’s condition, one must combine models. Ulti-
mately, every model is based on Yin and Yang. They are the founda-
tion upon which we build a dynamic model of pulse taking because
the pulses are dynamic. They have a dynamic character, a fundamen-
tal symmetry of Yin and Yang and we are reading the activity of Qi.
Everything that happens to the body and in the mind—emotions,
interactions with the environment, changes in physiological processes
or physical structure—is immediately reflected in the pulses. Pulse
diagnosis is the only real-time system of diagnosis and learning this
system will revolutionize your practice.
Pulse diagnosis can be expanded from the nine sector models

that we read about in the Nei Jing and Mai Jing to include event-time
calculation (for example, to determine when depression started), in-
tegration of modern concepts, and more. When examining the pulses
using this method, we look at channel (aka meridian) and organ per-
spectives in all three jiaos and at many levels during each visit. The
Nan Jing gives us the foundation for the organ and channel part but
not so much the idea that we can see the channels in each jiao and in
the distal, middle, and proximal positions. Not everything is written
down in the classics; they leave room for interpretation and growth
but give us important basics on which to build our knowledge.
Looking at the channels in each jiao and each wrist position

along with the Heaven, Earth, and Man divisions gives us a tic-tac-
toe nine sector model of the pulses. Then, we can add left and right
to the positions. We can look at the entire body by studying the
location of the movement that we feel in the pulses and extrapolating
that to a part of the body. You study the sector in which you feel the
movement, know the channel that it touches, the part of the body
and the jiao. This information helps you to make an accurate diagno-
sis. One example of how that works is what I call the “thyroid gland
short cut.” In TCM we have no thyroid pulse per se but we can still
figure out how to determine hypo- or hyperthyroidism in people by
studying the Large Intestine, Stomach, and Kidney channels because
the thyroid gland is near those channels and in the upper jiao.
The key is to physically and tactically learn what theory means

in terms of what you’re feeling in the pulse. The pulse is the most
important way that we can get information. Li Zhi Shen said that the
area and nature of the disease can be determined from the wrist pulse.
I say that Every pulse tells a story -the story of a person’s life. And you
need to know how to read that story. There’s so much information
there! In addition to giving you a wealth of information about what
is going on with your patients’ health, using the Pulse Balancing and
Treatment System allows you to show your patients their pulse picture
in black and white because you can draw how the energetic patterns
feel to you and then show them that picture. The drawing you make
of each person’s pulse is a picture of:
• How their overall energy is flowing or, on the other hand,
how blocked it is and where the blocks are located
• How their worry is negatively affecting their digestion
and therefore their ability to produce good quality Post-Heaven
Qi
• How their old unresolved emotional trauma is impacting
their Shen, Liver, Kidneys, and health in general
• How Qi is flowing through their organ systems (or not)
and what it means to their health when Qi doesn’t flow in a bal-
anced way
• Whether their Dai Mai is blocked and what that means to
their overall health
• The status of their Kidney energy and whether or not it is
successfully supporting other organ systems
• Whether or not they have stored grief
• Whether the organ systems are supporting each other,
communicating
• How old some of their symptoms are
• And much, much more.
In this book I discuss pulse movements that involve:

• More than one jiao
• More than one position
• Exchanges between different jiaos

• Exchanges between different levels (deep, middle, superfi-
cial)
• Exchanges between different positions (for example, is the
Liver supporting the Heart)
• Signature pulses for a variety of emotions or ailments
I will:
• Explain what the normal or balanced pulse looks like and
what it feels like under your fingers
• Explain how to use the pulses as a biofeedback system for
you to see the effectiveness (or ineffectiveness) of your treatment
in real-time, that is, as you are giving it. Without such feedback
from the patient’s body, how do you know that your treatment
is working? This system will give you that information. You will
not have to guess or rely on faith or the word of others that some
point combinations work; you will feel the answer for yourself in
the pulses
• Review fundamental pulse qualities that you may use in
this system
• Talk about the significance of pulse qualities in each pulse
position
• Explain the significance of movements in each position.
You will determine how the energy is moving or blocked, wheth-
er Yin and Yang are symmetrical, whether the organ systems are
communicating, whether one organ’s energy is attacking another,
etc.
• Describe pulse movements in at least three levels of
depth. Three levels is very basic; there are many more levels than
three. Each time you release pressure (just like a blood pressure
cuff does) and move toward the superficial level you are feeling a
depth. Theoretically, there could be an infinite number of depths
• Talk a bit about treatment options to help get you started
using this system
You will be able to show this type of information to your pa-

tients in the form of a drawing that you make while taking their
pulse. This gives you and them a visual representation of their pulse
picture - their imbalanced picture - to compare with a picture of

what a normal, balanced pulse looks like.
You can draw them a comparison:
Here is what a normal, balanced pulse looks like:
and here is what your picture looks like (just one example of the
possibilities).
You can show them their out-of-balance picture (above) com-

pared with what balanced looks like in black and white. Showing
patients how their out-of-balance pulse picture differs from a healthy,
balanced pulse is important information for them. Most people are
shocked by the differences between what balanced looks like and
what their picture looks like.
You have the opportunity to explain what it all means and let
them know that you are someone who has the potential to change
that picture. You have the skills to change their out-of-balance pic-
ture, their imbalanced flow of Qi into a balanced situation, a healthi-
er Qi flow, into a picture of health.
Using their picture, you can help clarify for them how their
symptoms developed and why they are persisting. Sharing this sort
of information about their history gives them power and a sense of
control because you make sense out of their symptoms or health con-
dition. Our ability to share how imbalances affect their health and to
explain that, along with our treatment and advice on how they can
make changes, allows them to be more of who they are meant to be -
a balanced, healthy person. I think that it is imperative not only for
us to tell people that they can make changes in their lives that will
improve their health, but that you can guide the changes by what
you see in their pulses. One example of how you can show them this
cause and effect is to explain that Qi can become blocked by various
emotions. Show them the Liver and Heart sectors on the picture and
talk about Liver Qi stagnation. Then, as treatment progresses and as
they make changes in their lives, it will show up in their pulses and
you can revise their picture for them. Believe me, they will ask “how
does my pulse picture look different than it did last time?” because
they are curious about how acupuncture (and other Chinese medi-
cine therapies) work to change the flow of Qi.
The Pulse Diagnosis - Biofeedback and Balancing System allows

you to talk with your patients about their lives in common terms
rather than in a way that is unfamiliar or foreign. It makes much
more sense to them when you say: “Do you see this movement in
your picture? This is worry making your Qi flow backward instead of
forward” than it does to tell them “you have Damp Heat in the lower
jiao.”
I remember Jim telling me that learning a new pulse diagno-

sis system is like sitting down at a piano for the first time. You are
faced with a lot of keys on the keyboard along with many choices
about which type of music to play. But you start by learning what
and where the notes are and practice playing scales again and again.
Then, you can choose to play classical scores, children’s songs, jazz,
country and western music, etc. The whole potential is there for you
to learn and practice but the learning, the expertise, is up to you to
practice. It is the same way with learning pulse diagnosis. You are
faced with positions, depths, movements, and textures that you can
learn to interpret along with the patient’s history and current medical
status. It’s very exciting, but it does take commitment and practice to
master.
Previously I said that I will explain how to use pulse diagnosis as

a feedback mechanism to judge the effectiveness (or ineffectiveness
sometimes) of your treatment as you give it. When you think about
it, biofeedback from the patient’s body is invaluable. The ability to
get this feedback as you place the needles makes this a real-time,
user friendly system. That is, you take an action (put needles in) and
then you take the pulse again to feel immediate results. Qi responds
immediately. If it doesn’t, then you need to change your treatment
plan. This system lets you think about all of the points, all of their
functions, the meridians, and unique combinations of points and
functions and how to use them to change the patient’s pulses. It will
absolutely expand your knowledge.
Here’s how it works: after you take the pulses, determine your
acupuncture *prescription, place some needles, and retake the pulses
to observe changes in Qi flow, connection between organs, deficien-
cies, excesses, etc. If you don’t feel changes in the pulses, then you
know that your acupuncture point prescription has missed the mark.
If placing needles doesn’t change the pulses, your choice of points
is not on target. But, let’s say that your acupuncture prescription is
correct or effective. Then, as you feel changes in the pulses after nee-
dling, you can determine what other changes need to be made in the
energy flow and continue with the treatment. Keep feeling pulses and
inserting needles until balance is attained. You will know when that
is, because a balanced pulse feels good under your fingers. It’s a nice
smooth, Yin and Yang flow.
Treatment is a step-wise procedure:

• Check the pulses
• Put needles in
• Check the change in the pulses
• Put more needles in
• Check pulses again
• More needles, more checking the pulses
• Keep doing that until balance is achieved
*Let me diverge for a moment and say a few words about what
I call “prescription Chinese medicine”. For me, that means using the
same acupuncture point prescription to treat a condition or symptom
across patients. For example, your patient complains of PMS, you
look up what points are used to treat PMS, and use the prescription
in the book. That is not what I mean in this book when I say that
after you take the pulses you “determine the acupuncture prescrip-
tion that you will use.” What I mean is that you will create a unique
acupuncture point prescription for each patient, each time you treat
them. Further, if their pulse picture isn’t changing after a few treat-
ments, then your individualized prescriptions are not working. In
my opinion, there’s a BIG difference between using the same point
“prescriptions” for everyone versus making unique prescriptions for
each patient at each treatment. Isn’t that the promise of Traditional
Chinese medicine: individualized treatment that treats the root? Our
medicine has the capability to see the root of symptoms and disease
in a very specific way and that root may be different for each patient.
Every woman’s PMS is not caused by the same thing. Using common
point prescriptions doesn’t serve the patients or our medicine well.
This pulse diagnosis system allows you to see how your treat-
ment works (or not) with each individual patient and at each of his
or her treatments. It allows you to do more than “prescription” Chi-
nese medicine. Remember, prescriptions don’t work for everyone …
and we know that from modern medicine. If the patient has depres-
sion; prescribe Prozac. But for some patients Prozac doesn’t work so
they try another drug, and another, and on and on. TCM is designed
to find the cause so the TCM way is to treat each individual’s de-
pression in a way that is appropriate and correct for that individual.

Using this pulse diagnosis system will allow you to see the history
of each person’s depression and the ultimate cause. We treat each
individual’s depression, each individual’s digestive issues, headaches,
etc. as a condition unique to him or her. The Pulse Balancing System
allows you to do that more effectively.
Once you begin to use this system, you won’t think about
what the patient’s symptoms are, try to figure out the pattern, and
then give them something for the pattern. The focus of the acupunc-
ture treatment won’t be on the symptoms per se. I can’t tell you how
many times I have forgotten to treat a patient’s shoulder pain locally,
for example, because I had become focused on changing their pulses.
Theoretically, if I restore balance to their body, their symptoms will
go away. So I focus on that restoration and forget that they are prob-
ably expecting me to put some needles in their shoulder. Remember,
with using this system, you won’t have to wonder if your treatment
is working. You won’t have to wait until next week when your pa-
tient comes in to tell you how he or she feels or felt after the last
treatment. You will be able to see changes right away in the pulses.
You will see the changes in the pulses as you give the treatment. In a
biofeedback system like this, whenever you put needles in you want
to see the change in the pulses and know right away whether your
treatment strategy is effective, not effective, or to what extent it is ef-
fective. Each treatment will be a test of your skills to change the patient’s
pulse picture and to change the flow of the Qi in their system toward
balance. Each patient’s pulses are like a puzzle. You know what the
outcome looks like - a normal, balanced pulse picture - and you have
to figure out how to put in the pieces (acupuncture points) to make
it work.
In all of the pulse positions, in all of the combinations, in all

of the patterns, there is a wealth of information that allows you to
know what’s going on in your patients’ bodies, including in the
emotional realm. You can see how their imbalances are manifesting
and especially how their emotions (past and present) are involved in
their symptoms or health condition. In TCM it is generally accepted
that emotions cause imbalances that lead to physical disease. In fact,

in recent years even modern medicine has accepted that emotional
stress negatively affects your health. Examining the pulses in the way
I am describing gives you the ability to feel the effects of emotions
on health and then talk with your patients about it. They will be
amazed, and they will listen because you are explaining their history
and their health in terms that they can understand and impact with
their own actions. Plus, they find it fascinating that you can feel “all
of that” in their pulses. Again, it will make much more sense to them
than talking about jiaos or slippery and wiry.
Here are a couple of cases that demonstrate how emotional

history can affect the pulse and physical health.
Case 1: The patient has a history of not feeling nurtured or

loved, not feeling accepted. Her Spleen position feels as though the
energy is actively sinking. It feels like your finger is being sucked
down and that no matter how deeply you press you will never feel
any Spleen energy. It’s a feeling of total emptiness. That is the pulse
picture of someone who needs some serious nurturing. This is the
patient who might say “My mother didn’t ever hug me” or “I didn’t
have a childhood.” This patient never felt loved as a child and in fact
remembered her first hug as the one given while she was walking out
the door to move away. This type of movement might also be felt in a
person who has nurtured others throughout her life but who has ne-
glected to nurture herself or receive nurturing. Being able to receive
from others is a big part of feeling loved.
Another example of this type of really deep Spleen deficiency

may be felt in a firstborn child who then has siblings or a sibling
with a health issue. He or she wonders “where did the attention from
Mom go?” Your patient just never felt loved or attended to because
his/her mother’s energy was given to the sibling with a health issue
and the Mom would say “Oh, I never worry about Julie, she always
lands on her feet,” implying that she never even thinks about Julie
because she has to focus on the other child or children. So Julie ends
up feeling unloved and her Spleen energy gets weaker and weaker.
Patients with this sort of deep emptiness in their Spleen either

already have digestive problems or they will eventually have them
because of the severe, long term Spleen (Earth) deficiency. They also
generally have immune system issues because the weakness of the
Spleen precludes any energetic support reaching the Lung/LI sector
in the pulse cycle. Remember, if the previous organ is too weak to
flow (in this case Spleen) then the next organ system (Lung/LI) isn’t
receiving any Qi support.
Case 2: This patient has unresolved emotional trauma. This sort

of emotional situation feels like the first part of the Liver pulse is
missing at the deep level, which is followed by a strong, rising move-
ment up toward the Heart. It’s like the patient’s middle jiao is empty,
except for the moderately strong rising motion out of the Liver. This
movement is attacking the Heart, the Spirit level. At the same time,
the perverse movement in the Liver position is sucking Qi away from
the Kidneys. How do you think that sort of perverse movement in
the Liver sector is funded? By the Kidney Qi. The result of this type
of movement is that the Shen or Heart is not receiving adequate
nourishment because our bodies naturally block that perverse move-
ment from reaching the Heart. Until this sort of emotional situation
is resolved, the Heart energy and Shen will suffer, the person will not
feel joy, the Liver energy will suffer because the flow has been stifled
(to protect the Heart/Shen), and the Kidneys will continue to be
drained.
Most of us Licensed Acupuncturists, Oriental Medicine Doc-

tors, Acupuncture Physicians, etc. are not Psychotherapists. But,
once you learn how to feel the effects of emotions and emotional
history on the energy flow of your patients, you will see that talking
with our patients about the effects that their emotions and lifestyle
have on their health is our responsibility as practitioners. I will
always remember a time in student clinic when Jim starting asking a
woman about her diet after he felt her pulses. She said, “I’m a vege-
tarian.” Jim said, “No you’re not.” The woman responded, “Maybe
you didn’t hear me but I’m a vegetarian.” Jim continued to tell the
woman, in his most non-charismatic manner, that her body was not
a vegetarian, asking her if her choice was for religious reasons, etc.
After a few minutes of that kind of questioning, he asked her about
her ancestors. She told him that her family came from a northern,
cold climate. That was what Jim was waiting to hear. He told her
that her ancestors were meat eaters and so was she. I was electrified
that a practitioner would talk to a patient in such a confrontational
manner. After we left the treatment room, I asked him about the
discussion with the patient and I’ll never forget what he said, “That
woman is on her way to serious health consequences. She already
has digestive problems and you can feel a situation in her pulses that
could eventually mean tumor development due to the perverse Qi
situation in those channels. If you felt that, would you just let her
keep eating the way she does instead of telling her to change? Aren’t
you here to help people improve their health? It is your responsibil-
ity!” Jim was right. It is our responsibility to give patients the truest
picture of their situation and concrete advice about how to get back
into balance. At the initial visit, I always discuss the imbalances I
feel in the pulses in a most comprehensive way. I show the person
his or her pulse picture, compare it to the balanced pulse picture,
and discuss the imbalances as well as the long term consequences of
continued imbalance. Yes, even with the person who comes in with
shoulder pain I am going to show him or her the picture and explain
the entire situation and how the shown imbalance can be a cause of,
or an exacerbating factor in the shoulder pain.
In Chinese medicine everything pertains to pulses –

• No matter what situation
• No matter what condition
• No matter what trauma
• No matter what disease
• Something in the pulses will change. You will see it.
Every pulse tells a story and you need to know how to read it.
Our pulses store and translate events. Everything that goes on

in a person’s life will show up in the pulses. Even years later there are
ways of looking at the pulses to see what happened in a person’s early

history. Nothing is omitted; no experience is deleted from the ener-
getic system. We carry our history with us and it can be felt in the
pulses. Very often, the reason why people don’t bounce back from an
illness or accident is because of the emotional stuff going on in their
lives and held in their energies. Illness can take hold because of the
thousand little traumas that continuously suppress the immune sys-
tem. Seldom is illness caused by one unique thing. Seeing how those
thousand little traumas from the past, those old experiences that are
still with the person and are currently affecting the patient’s health,
is like finding buried treasure in the person’s energetic system. As I
said earlier, you have enlightenment with every patient. This is what
keeps my interest, enjoyment, and fascination with TCM alive!
The earliest Chinese case histories talked of doctors prescribing

remedies based on pulse taking (palpation). We all know the classical
ways to examine a person’s condition:
• Visual examination
• Listening and smelling
• Questioning
• Palpation (pulse examination)
Historically, palpation has been considered the most important

and revealing of the diagnostic methods. In fact, there used to be a
similar interest in the pulses in the West. In the 16th century, Hercu-
les Saxonia declared that “nothing is or ever will be more significant
in medical science than pulse taking” and pulse taking was practiced
up until the 19th century in the West.
When you look at the monographs that were written about

TCM, there aren’t many that were devoted to diagnostic listening,
smelling, or questioning. The articles concentrated on palpating. This
means that if the pulses didn’t reliably reflect what is going on en-
ergetically in the body and show us how diseases present themselves
energetically, they (the pulses) would not have been given so much
attention or acclaim. That is why I am often surprised at the cursory
understanding of pulse diagnosis that many of us received from our
formal TCM education. That lack of education left us ill-prepared

to practice anything but what I call “prescription Chinese medicine.”
We know how to look up acupuncture prescriptions in books. Some
practitioners do that because they are not able to do an adequate
pulse diagnosis and therefore must rely on the symptoms that pa-
tients report and on treatment prescriptions that were memorized
in school or can be looked up in books. One of the beauties of this
system is that it is a practical application of classical information,
information that is often complicated to read and understand. The
habit of the classics is to mention things and then leave you to figure
it out. Ancient authors (and translators) didn’t readily interpret the
information for us. They put the idea out there but didn’t clearly
show how to put that information or idea into application. That may
be where some of the confusion in pulse diagnosis originates.
While this system allows you to see a great deal of detail in your
patients’ pulses, in some ways it is simplified, compared with some
other pulse diagnosis ideas. In the Li Shi Zhen Pulse Diagnosis book,
for example, there are 27 basic pulse types. It is utterly confusing
and somewhat bewildering to organize them. You wonder how to
keep them in your head and how to interpret them. In my system,
we will look at about a dozen pulse shapes or textures and how those
differ from the normal, balanced pulse shape and movement. Because
that is the key: how are the movements that you feel in the patient’s
pulses different from the normal, balanced pulse? Is there a quality
to his or her pulses other than balanced? Does slippery go away when
the pulses are balanced? How do the patient’s pulses look when com-
pared with what is normal and balanced? These are the questions that
you will be equipped to answer. So really, learning 10 or 12 basic
shapes or textures and how they differ from normal is a greater set of
information for you to use than knowing fifty or even one hundred
pulse quality descriptions.
This system is about interpreting the physical space that you are
examining under your fingers. You will be able to make a connection
between what you understand in theory and the sensation that you
feel while taking the pulses. You will see what’s going on differently
at the surface than in the interior. You will have the ability to iden-
tify emotional things going on with the patient and more by seeing
what shape the pulse is and how it is moving (or not) in the various
positions. No matter what your patients say about themselves during
your intake or on their medical history, you will see the truth in their
pulses. People don’t misrepresent themselves or their situation on
purpose for the most part. But I have found it to be true that many
patients are unaware, inaccurate, or unwilling to say what’s really
going on with them. For example, the state of their digestion is very
frequently reported inaccurately. Patients pretty consistently report
that their digestion is “great” or “fine” or even “perfect” when asked
about it. Then, as I am feeling their pulses and seeing that their di-
gestion is not “great” or “fine,” I will ask questions like “are you cer-
tain that you don’t have any bloating or feel too full after eating even
a small meal?” Or, “it seems to me from your pulses that you might
have a tendency toward constipation.” I can’t tell you how many
times patients look at me and say (surprised) “Yes, actually I do get
bloated” or “That’s true, I can tend to be constipated.” My favorite is
that they forget to tell me that they are taking Nexium or some other
pharmaceutical to aid digestion because they just don’t even realize
that acid reflux is a digestive problem. They are so used to just taking
a pill for it that they think of it as normal now. Your pulse taking
ability will allow you to see the truth of what is going on in patients’
bodies. Your ability to see that and ask them relevant questions while
you are feeling their pulses makes TCM so much more real for them
- and for you.
Here is a case in point about a patient not being forthcoming

when asking her about her history. My very first fertility success pa-
tient was a woman who had gone through several modern medicine
infertility treatments including IUIs and IVFs. None had worked so
her fertility specialist declined to treat her further; she had reached
her limit of fertility procedures. She was determined to have a baby
and found another fertility specialist who agreed to do one more IVF.
On her own she did some research and found that the combination
of modern medicine techniques and acupuncture has a higher success
rate of conception so she came to me for acupuncture. While feeling
her pulses I could tell that she had some strong unresolved emo-
tional trauma that was preventing the smooth flow of Qi from the
middle jiao to the lower jiao. In fact, that out-of-balance movement
was depleting energy from the Kidneys - because they are what fund
the Liver and other organ systems. When I said something about
it she said “No, I don’t have anything like that.” NOTE: when the
patient doesn’t agree with the pulse reading it is very important for
you to believe what you feel and write it down. If the patient is not
in touch with that part of his or her life and therefore cannot “ad-
mit” to it, that’s another issue. What you need to do is believe what
you feel and treat what you feel because what you are feeling is the
truth. That’s what I did in this case; I believed what I felt and treated
accordingly. In other words, I treated what I felt despite her denial of
any old trauma. On her second visit she came, without her husband
in the room (so that could have partly determined her answers in our
first visit), and the first thing she did was remind me that during her
last treatment I said something about unresolved trauma. She then
told me that her brother raped her repeatedly when she was younger
but that “it was all resolved and we are now friends.” I told her that
despite the fact that they “are friends” and that “it’s all resolved,” the
trauma was not resolved in her body’s energy. Further, the area of
the body that was traumatized was the exact area of her concern: the
reproductive system and lower jiao. We continued to work to resolve
that energetic block and her next IVF treatment worked!
This case brings up a good point about how making an accurate

pulse diagnosis can be especially important when making up your
point prescriptions. As I alluded to above, this patient had a very pal-
pable block in her Dai Mai. The energy was not flowing between her
lower, middle, and upper jiaos or between the Kidneys and Heart.
If I didn’t know better – in other words, if I’d only used the infor-
mation that I learned in school, which was to tonify the Kidneys for
fertility issues, I don’t believe that I would have had success with this
patient. For one thing, if the energy flow is blocked, would tonifying
the Kidneys have been an effective treatment plan? I doubt it. Where
would the energy that had been tonified go? .... Exactly. It couldn’t
go anywhere and the treatments would not have been effective. In
fact, treating in such a fashion may have even created stagnation and
Toxic Heat in the lower jiao. In this case, I was very lucky to be able
to feel the Dai Mai block, resolve it, and then do tonification work as
needed. I owe this success (and many others) to my knowledge of the
Pulse Balancing and Treatment System.
The critical thing is that you want to be able to take the pulse
and get the information that patients don’t want to report, that they
can’t feel because they’re not in tune with their physical body and
things going on that they don’t understand or can acknowledge.
Sometimes that’s because the movements are very old and have be-
come adapted patterns so the person is just used to them. This ability
is what will allow you to be even more effective in creating and im-
plementing your treatment strategies.
Chapter Two
Looking at Different Models of Pulse

Diagnosis
Unfortunately, American authors cannot describe or teach this level

of sophistication and complexity. Typically, contemporary texts divide the
pulse levels into the Yang and Yin organs, and then specify a diagnosis
method using TCM’s Eight Principles in the cun, guan, or qi positions.
Many different types of problems are reduced to the same, elementary
rubric— “stagnated Liver energy,” “Dampness in the Spleen,” etc. As a
result, complicated and chronic problems can easily be misunderstood,
misdiagnosed, and inappropriately treated. When contemporary com-
mentators take the relationships found in the pulses and parse them
down to smaller and smaller pieces for analysis, this is simply the most
harmful aspect of the Western mind at work—reductionist and mechan-
ical; unmindful of the holistic view and inductive reasoning of the Chi-
nese mind. It fails to see the richness, subtlety, and interaction of a living
system. Pulse movements are an alphabet which can build into elaborate
descriptions; not a kind of Morse code. (from On Li Shi Zhen’s Pulse
Diagnosis by James Ramholz, Dipl.Ac., O.M.D.)
Methods of Pulse Diagnosis

There are many models of pulse diagnosis. It is an ancient
diagnostic art and iterations of it have been created by a number
of people. Each model views the body and the internal organs
from a different perspective of structure and energy. One model
of pulse diagnosis is not necessarily more valid than another.
Each has its advantages and disadvantages, and some are so very
different from one another that it can actually create some doubt
that pulse diagnosis is a valuable or realistic diagnostic method at
all. Sometimes in order to gain a complete picture of the patient’s
condition one must combine diagnostic models.
The fact that you are reading this book does not mean that
you are going to forego everything that you already know about
the pulses. And you will still use visual examination, talk with the
patient, observe patterns in his or her speech or movements, look
at the tongue coat, etc. But the information you get from those
methods might seem ambiguous when compared with the richness
of detail that you will feel in the pulses. My goal is to give you a
different way – a new way, a new skill – with which to read the
symmetry (or lack thereof ) of Yin and Yang in your patients. That is
what this system is about: reading how the current pulse situation in
the patient differs from the perfect, balanced, normal symmetry of
Yin and Yang across organ systems. Ultimately, every model of pulse
diagnosis is based on Yin and Yang. Yin and Yang are the foundation
upon which we build a dynamic model of pulse taking. You need to
use a dynamic method or model because the pulses are dynamic; they
are a reflection of life in the body.
One dimensional model

In a one-dimensional model of pulse examination you feel
something in the pulses - a feeling, a texture ... something and
generally you feel something in one position at a time (cun, guan, or
qi). It’s like a wire that is transmitting physical information. You feel
one thing in one position or maybe one thing in the entire position
interpreting all of the jiaos as one thing. Pulse diagnosis is not just
some sort of intellectual exercise; it’s a very physical thing and the
one dimensional model feels one thing, a single movement.
The one-dimensional model is what some of us learned in

TCM school. We didn’t divide the pulse into vertical levels to find
Yin pulses and Yang pulses. The focus was on the texture as a single
sensation, shape, or movement felt under our fingers. We were trying
to feel one thing, a one-dimensional pulse movement. Sometimes
even depth isn’t considered. If teachers didn’t give us much more
information than that it was because they didn’t have very much
information. How many times did I hear my teachers say “It’s slippery
and wiry” while in student clinic? If that’s all they were looking at, if
that’s all they were able to see/feel, if that’s their entire perspective on
what’s going on in the patient’s body, then they didn’t have much to
tell us. “Slippery and wiry” doesn’t really give you much information
about the patient’s health especially compared with the information
that this Pulse Diagnosis - Biofeedback and Balancing System will give
you. There’s much more to see so slippery and wiry is not enough
but it is true that you have to start somewhere. You have to get some
sort of information from the pulse. Can you make a difference in
someone’s health if all you can feel and treat is slippery and wiry? Yes.
I have been known to say that “some acupuncture is better than no
acupuncture.” But the model I teach you takes you far beyond the
one-dimensional model, far beyond just getting one piece of basic
information from your examination of the pulses. A one-dimensional
system of pulse diagnosis expedites deduction but at the price of
seeing more detail, much more detail, and a more effective treatment.
And, it ignores the dynamic quality of the pulse – the energetic flow
that is a living human being. It basically ignores everything except
one quality or one texture.
There is considerable ambiguity in a 1-D model even when it

uses the full capability of the Li Shi Zhen because it still neglects
the wealth of technical material found in the Nan Jing and Mai
Jing. We can make this basic model more detailed by dividing each
position into zang and fu levels. Or, if we extend Eight-Principles
and divide each position into three horizontal levels, we can begin
to look at the Qi, Blood, and Organ values of the movement in each
position. Regardless, we are interpreting a single pulse movement.
(from An Introduction to Advanced Pulse Diagnosis Theory and
Clinical Practice in Light of the Nan Jing, Li Shi Zhen and Mai
Jing by Jim Ramholz).
It is simply not enough to only look at one thing in one position

or to look at the entire pulse as one general texture or shape. That
doesn’t give you very much information at all. If you want to see all
the details that are going on in the body, if you want to know the
depth of information that is there, if you want to be more effective
in your treatment, then you need to move on to start using a more
complex model of pulse diagnosis. You need to use a model that gives
you more details and therefore more information about the patient.
It is true that:
The art is in the details ….. so is the successful treatment.
Two level or two dimensional model

A two-dimensional model is when you divide the jiaos in half
and look at what’s going on separately in the upper and lower depths.
The top and bottoms are discreet and separate. The Yang half (top
depth) is the hollow/fu organs; the Yin half (bottom depth) is the
solid/zang organs. It’s two planes, each being discreet, separate, and
integral to itself.

The bottom starts deeply where there is little to no movement
and the very top is where the movement is no longer felt. In the
middle somewhere is the dividing line between Yang and Yin. Feeling
both depths means that you are looking at the whole jiao. When
you physically come up a little higher you are only looking at the
qualities of the hollow/Yang organs. You are looking at the qualities
of the Gallbladder, Small Intestine, Stomach, Large Intestine, etc.
When you feel deeper you are feeling the energy of the Yin organs
(Spleen, Lung, etc.).
The significance of the two-dimensional model is that if

someone has gallstones or Gallbladder congestion you can look for it
or see it in the top (Yang) half. Theoretically, if they have a problem
with the Liver you will see it more deeply. And you’ll see it separately
and distinctly. It will be identifiable as something happening in the
Gallbladder or something happening in the Liver. The two wave
shapes or textures may not even look alike or be connected. Using
this sort of pulse diagnosis (two-dimensional model) allows you to
see the relative strength or weakness of the hollow and solid organs.
This sort of diagnosis may be significant because you have that
rule that if one organ goes excessive the other goes deficient. Or, if
organ is out-of-balance so are others. This is an example of seeing
something in the pulse rather than just knowing it as a theoretical
construct. Looking at both the Yin and Yang organs implies that
there is a connection between them and that each element should
connect with the next. But in the two-dimensional model, there is no
connection, there is no flow between Yin and Yang because you are
looking at them as discreet positions.
To read pulses differently, we need to change our examination

of the pulse in two ways. First, we regard each of the nine sectors
on both wrists as having an interpretive significance of their own.
The classics say that the cun position shows everything above the
diaphragm, the guan everything in the middle jiao, and the Qi
from the navel down. We are looking at three different levels and
three different pulses in each of the cun, guan, or qi positions, for
a total of nine sectors on each wrist. If we follow the physical logic
of the classical Li Shi Zhen model, then the superficial level is the
Qi, skin, and interaction with the environment; the bottom third is
the organ and bone level; and the middle third is the physical space
between those layers, the Blood level or organic function. (from
An Introduction to Advanced Pulse Diagnosis Theory and Clinical

Practice in Light of the Nan Jing, Li Shi Zhen and Mai Jing by
Jim Ramholz).
San Jiao Physical Model

Like most pulse diagnosis models, this model starts from
examining the pulse locations on the wrist and analyzing the
energy passing through a particular position. The classical three
jiaos form a hologram or miniature image of the whole body and
positions correspond to organs etc.. The positions refer to the
upper, middle, and lower jiao and the depth refers to the exterior
and interior. It’s similar to the two dimensional model of diving
the pulses into fu and zang organ pairs. Like the methods of
diagnosis using the eye, tongue, and ear, it paints a generalized
picture of the anatomy. By itself, it does not offer sufficient detail
for highly complicated or severe problems.
Three levels or three-dimensional model (the one this system

uses)
What is the information contained in a three levels or
dimensional model?
If we view the pulse three-dimensionally, we can see it as a

model that outlines the whole human body. We learn that the
energetic flow of the human body is such that the flow of Yang
starts at the hands and the flow of Yin starts at the feet. The classics
thought of this as Yang corresponding to Heaven and therefore flows
downward (in their “anatomical position” the hands are raised above
the head).
From the three-dimensional point of view, the superficial depth

belongs to the surface of the body, the middle belongs to the muscles
and joints, and the deepest depth belongs to the core of the body,
especially the internal organs. The superficial depth of the right
wrist shows the front of the body and the superficial depth of the
left wrist shows the back of the body. The upward dimension along
the horizontal axis from the guan to the cun is the connection from
middle to the upper jiao, and the downward horizontal direction
from the guan to the qi is the connection between the middle and
the lower jiao.
In a three level model, the:

Top/superficial level gives you information about:
• the skin
• everything going on near the surface (disease activity at
the surface, the exterior energetic level that hasn’t affected
organic structure yet)
• emotions (the patient’s emotional state or an emotion’s
influence on a particular organ)
• meridian activity
• Qi activity
• the peripheral nervous system
The top level is about the body’s interaction with the

environment.
Middle belongs to Blood. It will show you:

• the functional aspects and internal mechanisms of what goes
on in the body
• organic function (that is, a disease is in the organic level)
• metabolism
The middle level shows the interface of the surface or

environment with the interior mechanisms.
Bottom/deep belongs to the bone.

• it is the adaptive level
• information deep inside is felt here
• organ level, the physical structure
• marrow
• patterns that are fixed or that have been learned over years
are felt at this level
• chronic disease that is about to be stored or adapted to by
the body
• organ function
• unconscious or hidden emotion.
The bottom level is about old, deep, adapted patterns of
emotion, physical adaptation, and movement.
In three levels you are looking at the Yin/Yang balance in each

sector or each square of the drawing. What creates the three levels?
Pressure. Using different pressure with your fingers creates the levels
from deep to superficial. Feel the movement and ask yourself:
• What is this information about?
• Is it information about something going on at the emotional
level?
• Is it something going at the surface?
• Is it something going on in the metabolism?
• Is it something going on in the organs, in the adaptive level?
Determining the level in which you feel the movement will

help answer those questions. You will also be noting whether the
movements are moving from one position to the next.
We actually touch a three-dimensional object. A 3-D object

viewed in one or two dimensions is only a projection or shadow.
There is nothing wrong with such models; they are very effective
and contain enough information that it can take years to develop
skills in using them. In a three-dimensional artery, we actually
have three degrees of freedom in pulse movements. The Mai Jing

suggests that the cun (and other positions) can be seen as a bagua
pattern by dividing them into superficial/deep, proximal/distal,
and left/right portions. (from An Introduction to Advanced Pulse
Diagnosis Theory and Clinical Practice in Light of the Nan Jing,
Li Shi Zhen and Mai Jing by Jim Ramholz).
You may have noticed that I haven’t even talked about the qual-
ity or wave shape of the movement yet – whether it’s slippery, wiry,
thin, etc. That’s because the physical space that you are feeling defines
a certain diagnostic perspective right away. That’s the new way to
think about what you are feeling or what you are “looking at” in the
pulses. In this model we are reversing what many of us have done
in the past. In the past, we looked at the wave texture and general
information. Here we are reversing that. First you look at where the
movement is and what organ or channel it pertains to and then you
look at the texture.
You may want to ask, “What is the significance of having three

levels outside of making pulse diagnosis more complicated?” The
answer is that using three levels not only gives you more information
but more precise information. And really, as I stated earlier, there are
many more than three levels, but seeing or feeling at least three levels
is much more informative than looking at only one or two levels or
just looking at textures. For example, in looking at multiple levels
you can see what’s fixed and what’s not fixed in the person’s energy.
Why is this important? Because emotional, metabolic, and/or physi-
cal patterns that become fixed (i.e., deep, consistent movements) are
there as a result of chronic stagnation, long standing weakness, old
emotional trauma, etc. and are often the cause of health problems.
The significance of three goes further. In TCM, you see three a

lot - Heaven, Earth, and Man; the trigrams of the I Ching; Qi, Jing,
and Shen. So there are many things grouped in threes. In complex
systems there have to be at least three levels. If there are only two lev-
els it’s a fairly mechanical system; it’s not really alive. Three levels is
sort of the minimum requirement in terms of complexity. And pulse
diagnosis examines a living system! So with the pulses when we move

from two levels to three levels we move from a more mechanical sort
of system to a system that’s so rich in detail that we can start to see
all the patterns of energy and the results of those patterns.
To review: we are now looking at three different levels. We’re

looking at the richness and detail of how a person relates to their
outside environment (the top level), how they work inside themselves
(the middle level), and what’s going on at their physical structure,
their adapted energetic and behavioral patterns (the bottom level).
If you can physically separate with your fingers and in your mind
what’s going on at one level, what’s going on at another level, and see
how those levels relate to one another, your pulse reading ability and
the information that you receive from your pulse taking will greatly
expand. Your diagnostic universe will explode! When you are feeling
the patient’s pulse, remember to always think about or picture the
normal sine wave as your standard (more information about that
coming up in Chapter 3, The Normal Pulse). It will be your goal of
every treatment. Remember that in the normal, balanced movement,
there is nothing fixed. Everything is flowing; everything is moving.
Buddhists are right: everything is impermanent. The pattern is there
but there’s no permanence to anything; there is only flow. When you
begin to see fixed patterns at any level, those are the pathological
patterns that can give you information about everything going on
in the person. Further, if the person is unaware of the pattern or it
hasn’t created symptoms, yet then you have to figure it out because
it’s holding other energetic movement back and is indeed creating a
problem that will eventually manifest as physical symptoms and/or
disease. We have the opportunity to change a person’s life by feeling
patterns and perverse movement. I felt the signature for breast cancer
in a patient a few years ago. I asked her when she had had her last
mammogram. Her response was that she had never had one (at 65
years old) and didn’t intend to ever have one. I strongly encouraged
her to do so; told her that I felt some “stagnation” that was maybe
just fibrocystic breast tissue but that it is good to know about that
sort of condition. Turns out, she had breast cancer. You could say
that pulse diagnosis saved her life.
You may end up looking at a whole jiao, dividing a jiao into Yin
and Yang, dividing the jiao into superficial, middle, deep and even
(someday) dividing each of those three into three. The system will
develop even more because you’ll see patients manifest in all different
ways. So you need to be open to looking at the pulse in a few ways.
If you just focus on one specific part of the system, like only looking
at the whole jiao, then you ignore lots of information. If you’re a
podiatrist, you specialize in the feet. But if you only look at the feet
while ignoring the rest of the body, you’re not a very good podiatrist.
Some practitioners are going to have a favorite pulse diagnosis mod-
el, no doubt about it. But if you can’t see it, you can’t treat it. Your
treatment will either be unsuccessful or you’ll get lucky. The danger
to the success of our medicine is that if you don’t want to do any sort
of advanced pulse diagnosis work you’ll have the jiaos, you’ll have
your wiry and slippery, - you’re set for life. You have a career in acu-
puncture! But you won’t be able tell you if the person is developing a
tumor. It would be like looking at early x-rays and saying that that’s
the closest medicine will ever get at seeing what’s going on inside the
body. Now we have MRIs, CT scans, etc. that give us so much more
info than the original x-ray. It’s the same with pulse diagnosis: you
can either be an expert or just mediocre.
Every pulse tells a story and that picture shows everything that
one has lived in the pulses. Your job is to be able to read the story.
And, unlike the eye, tongue, and ear, this Pulse Diagnosis - Biofeed-
back and Balancing System offers a real-time view of the energetic
activity of the body. This is the most indispensable feedback for
effective treatment. No matter what the patient presents to the prac-
titioner, we can see the root and the branch of the problem in the
pulses. The patient cannot mislead a practitioner through omission
or naiveté. I tell them that they “can’t hide from the pulses” … they
can’t hide from the good diagnostician. In fact, we can see a prob-
lem develop and treat it before the patient is aware of its symptoms.
When we examine the patient and put the needles in, we can see the
changes in the pulses as they happen; more importantly, we can use
this immediate feedback to select point combinations to our - and
their health’s - greatest advantage. We know by changes in the pulses

how effective our needling is (or not), how much we have changed
the condition (or not), and can then predict how the condition will
improve between treatments.
The physical space and the movements that you feel under your
fingers are telling you what is going on with the patient. Not only
do you need to look at the quality of the movements as you may
have done in the past, you have to look and see where that wave is in
physical space. Which of the nine or so sectors is it in? Because the
primary bit of information comes from the physical space in which
you feel the movement. That is the first order of diagnostics: where
in space is the movement happening (location, location, location).
Then you can determine how it is integrating – or not integrating –
with the other movements. Think of each of the depths and segments
(the three segments where your fingers fall) as a window into what’s
going on with the person while keeping in mind which one shows
what. You can go through one and then through the other …. look-
ing at what’s going on with Kidneys, what’s going on with digestion,
is the Spirit getting adequate energetic support, etc. Any movement
that you feel that is away from symmetry (the normal sine wave) is
abnormal, perverse, or out-of-balance. This is the most important
thing because the symmetry, or lack thereof, is your connection be-
tween the sensation you feel in the pulse and what is going on with
the patient.
I need to say a bit about symptoms. What are symptoms? Symp-

toms are a contrast, a variation, a move away from homeostasis, a
sign that the person’s energy is out-of-balance. For example, Heat
or Cold should be able to come into the system, the healthy system
handles the Heat or Cold, and everything gets mixed together and
balanced. Even the stuff that happens in your emotional life, any sort
of trauma, any sort of aggravation, any sort of worry should be able
to just get mixed in and not become a problem that leads to symp-
toms. If our stresses could just mix in like that, the general emotional
state of people would be mellow and balanced. But how many people
do you know who are mellow? Not too many. If they seem mellow
on the surface, they’re not always mellow inside. In fact, some people
have a very adapted personality – they’re fun to be with, seem calm
and happy but then they go berserk. Granted, that’s an extreme case.
They have a lot of stuff going on inside, they’ve just adapted to it,
and their social personality has adapted so that they can be with oth-
er people. But now you can start to see the separation of their outer
life from their inner life in their pulses. You can see what’s going on
inside and what they’re holding inside by feeling those imbalances in
their pulses. The point? Emotions and emotional history definitely
affect the pulse.
Everything that you learn, everything that you know, can be

related to the pulse. This is where you meet the patient. And with
this method of pulse diagnosis you will have much more information
than anyone else, than other practitioners, because you will be able
to see these different things in the pulses and get much more infor-
mation.
You may now wonder about how to apply this diagnostic system
using your style of treatment. How does that work? Well, there is no
unity in the practice of Chinese medicine in my opinion and experi-
ence. Practitioners are treating patients in many different ways. Those
who have taken my pulse diagnosis courses know that, during the su-
pervised practice hours, I allow practitioners to use whatever strategy
of treatment that they always use - but now they have a pulse diagno-
sis system that can test their mode of treatment for its effectiveness.
Even though someone uses a different system of treatment than I do,
I encourage them to use the same diagnostic model because they will
be able to see whether their treatment strategy works by re-examining
the pulses. And besides, their treatment strategy has a history, rules, a
theoretical underpinning, and hopefully a literature where I’ll bet we
can find common ground between their strategy and mine. Much of
the time the difference comes in the application of the theory.
This three dimension or three depth system will give you a great
deal of information about your patients’ health. There are actually
four dimensions - the three dimensions of space and then add in the
dimension of time. This is how we can start thinking about things

that happened years ago. It’s because we can feel the break in symme-
try from the person’s whole life, not just what is happening here and
now. So, you can think of this as a four-dimensional sort of pulse
diagnosis model and that adds another huge range of information.
We can also look at five levels instead of deep, middle, superficial.
Those are: skin, nervous system especially peripheral nervous system
(Heart), connective tissue (Spleen), deeper musculature (Liver), and
bone (Bone).
The first order of pulse diagnosis you can see is general systemic
things, but you will also get very detailed information.
Chapter Three
The Normal Pulse
It is imperative to know the normal pulse or the pulse seen in the

healthy person before the morbid pulses are to be learned because a
morbid pulse is in fact the abnormal change of a normal pulse.
This quote from The Practical of Jin Wei’s Pulse Diagnosis says it
all about the importance of knowing how a normal, balanced pulse
feels. If you don’t know what normal feels like then how can you
know how a deviation from normal feels? Being able to feel a normal
pulse should be the foundation of any pulse diagnosis system. It is
the objective measure of the patient’s health situation and a practi-
tioner’s guide to prognosis and effective treatment. If you don’t know
how to feel a normal balanced pulse in your patients then you have
no goal in treatment. You have no evidence that your point selection
worked. You are just hoping and believing that your point selection
is working but you do not know that for certain unless you have the
ability to feel a balanced pulse during the treatment. Remember,
determining how much the patient’s presenting pulses differ from
a healthy or balanced pulse is the basis for your diagnosis. Being
able to feel and make that comparison is essential to your creating
an effective treatment plan. Since a normal, balanced pulse is your
goal and you know how to feel it, this pulse diagnosis system allows
you to get constant biofeedback after you insert needles. The ideal,
normal, balanced pulse is the goal of each of your treatments. And
frankly, the normal and balanced pulse is the simplest and most im-
portant place to start.
Have you ever thought about what exactly the pulse is? Here’s
what Jim wrote about it - The energy that pumps the Yang energy of
the pulse wave is Wind (feng) energy and the energy that pulls the Yin
energy down on the Yin pulse is Cold (han) energy.
The picture of perfect health when felt in the pulses is a sine

wave, the Tai Chi symbol, the perfect balance between Yin and Yang.
In some classical literature it is called the huan or zheng chang mai
pulse. We will call it the normal pulse. The name might seem a bit
strange but it is only a name, and the only thing that it means is that
it is the basic pulse that does not indicate any abnormal, pathogen-
ic activity. In the normal pulse, you feel energy that is not flowing
excessively or deficiently in any given direction and it is generally
flowing in the tonification direction, from proximal to distal). The
wave rises and falls with the same strength (the Yang upbeat and
Yin downbeat are equal), it has a nice rhythm, and the positions are
connected to each other both horizontally and vertically. It is sym-
metrical in its timing, dimensions, and texture. This picture of health
means that the energy in the jiaos from organ to organ is vibrant and
connected. You, the practitioner, should feel the balance of Yin and
Yang in each jiao and at each level in each jiao. The perfectly healthy
person would present with this sort of smooth, balanced pulse move-
ment. Now, even when the pulse is normal, men might have stronger
pulse in the chi (proximal) position than women. That’s because the
male depends on having more Yang energy.
But, the normal, balanced pulse is not likely to be seen in most

patients because it requires a lot of Qi that hasn’t been impacted yet
by life or emotional stress. One might even say that the normal pulse
is a bit simple, that the pathological pulses are more interesting.
That is true in the sense that pathology leads to more complicated
activity in the pulses. By the time people come to see us they are
having symptoms or health crises that have used up Qi and created
imbalance so you will have the opportunity to see lots of compli-
cated pulses. Still, our goal of each treatment is to get the person’s
energy (pulses) as close as we can to the perfectly balanced picture,
the perfectly balanced energetic system. This sort of treatment plan
can break the old energetic patterns and retrain the body to be more
balanced.
The normal, balanced pulse feels nice and smooth. If each organ
is balanced that’s one thing. But when you can feel (some practi-
tioners say “see”) the connection between the organs, that is balance.
Feeling the connection between organs is very important; it is the

quintessential sign of good health - the organs communicating with
one another - energy flowing through the system. Everything is nor-
mal and balanced. For you this will be a physical sensation. You can
feel balance and you will look for balance during every treatment.
In fact, look for it after every needle or every few needle insertions.
Common old fashioned descriptions of a “normal” pulse include that
it feels “regular, neither fast nor slow, and slightly slippery.” This sort
of description is usually associated with healthy digestive (Stomach)
Qi. But what does feels regular mean? How much slippery is “slightly
slippery?” The description is fairly ambiguous. Another commonly
held opinion is that “normal” goes according to the seasonal influ-
ence on the pulse and that the most significant thing is to see the
change in depth or quality as the seasons change. For example, the
overall pattern in winter should be deeper, but in spring it should
come up. In summer, because it’s so hot, all the energy and heat go
to the surface so the pulse will be more at the surface. Then in the
fall it goes back down. The energy goes through this cycle of circula-
tion, up and down. But you don’t always see that in people do you?
For example, let’s say that it’s summertime and the patient’s pulses
are very deep. Or in wintertime they’re all up at the surface. What’s
the problem there? It may just be that the patient is definitely not in
sync with the seasons. But even if, ideally, everyone should be in sync
with the seasons, the season should not control the pulse movement.
All healthy patients should show the balanced, smooth, even sine
wave regardless of the season. The energies of the seasons may mix in
with the balanced movement, not replace it.
The normal balanced pulse, according to this system of pulse

diagnosis feels like a sine wave. It is a smooth sine wave type move-
ment that is connected from organ to organ and from depth to
depth. Maybe there’s a little bit of Dampness to it to give it a bit of
substantialness to be the counterpart of the season’s energy. The nor-
mal, balanced pulse begins with a Yang (ascending) movement. The
convex portion of the wave show the Yang or Qi of the movement.
The concave part of the wave show the Yin energy or Blood in the
organs. The sine wave ascends (Yang) and descends (Yin) evenly; it’s
symmetrical and the Yin and Yang capacities are equal. Picture the
sine wave in the Tai chi symbol; this is the movement of a normal,
balanced pulse. This shows that the person is healthy and that all the
energy is mixing together. This doesn’t identify one element more
than the other; it shows that there’s communication between all the
elements.
In a perfectly healthy person, all the pulses would present this

smooth, balanced sine wave movement connected at all positions
and depths—and it should be present during the entire year, not
only in late summer. (from On the Li Zhi Shen’s Pulse Diagnosis
by Jim Ramholz).
How many times have you seen this picture of Qi flow in your
patients - a balanced, organized flow?
Granted, a sine wave is not what Li Shi Zhen says is normal, but
his description of the middle pulse, the Spleen/Earth pulse, is remi-
niscent of what we call normal in this system.
….. the middle pulse of the Spleen and Stomach feeling

“regular, neither fast nor slow” comes close to accurately portray-
ing the symmetry, energetic balance, coordination, and harmony
expected in a healthy pulse movement.
He alludes to the idea of the sine wave. The sine wave is the only
pulse you should think of as normal. Some sources say that the Liver
pulse is normally wiry, the Heart pulse normally has a hooked shape,
the Lung normal pulse is sort of feathery, and the Kidney normal
pulse is stony. No; don’t ever think that. Those qualities are a signal
that the organ and/or its system is moving toward imbalance, if it is
not already out-of-balance. An individual organ with its own distinct
energetic quality or movement is no longer in communication with
the other organ systems. That is, rather than being a part of a bal-
anced sine wave-type flow, the organ has separated itself out and is
now showing a movement other than the sine wave.
In On the Li Zhi Shen’s Pulse Diagnosis Jim comments:
The Normal pulse is often identified with the Stomach

energy because it is the organ which supplies nourishment and
support for all others. Together with the Spleen, the Earth Phase
absorbs, coordinates, and transforms; five elementally, it is at
the center of the sine wave movement. The substantive quality
attributed to its pulse character is also indicative of that nurtur-
ing and supportive role. For example, that central importance
is emphasized in the seasonal 5-Phase scheme: each Phase com-
municates with the Earth before cycling to the next Phase in the
Shen cycle.
What does a movement that looks like a sine wave show that
those other so-called “normal” pulses do not? When you see the pulse
as a sine wave, the ascending portion is Wood, the cresting portion
is Fire, the descending motion is Metal, and the trough or returning
is Water. Earth is 18 degrees out of each or associated by the overall
balance. If we think of the face of a clock, each movement centers
around 9, 12, 3, and 6 o’clock respectively. So the pulse actually
reflects both the daily and seasonal movement of time on a smaller
scale. The spatial directions are derived simply by association.
The sine wave means that the patient’s energy is connected

everywhere and at all levels. This system is always about symmetry
and whether you feel any breaks in symmetry. From your knowledge
of the feeling or sensation of the sine wave you can get anywhere.
Anything that does not feel like the sine wave is an indication to you
that the energy is out-of-balance. That’s what I mean by “you can
get anywhere” from knowing what the sine wave feels like - you will
know that any other feeling is imbalance.
In the sine wave, the front half is Yang and the back half is Yin.
Yin and Yang are exchanging, communicating, and connecting. They
are transforming into each other. That’s what life is – the constant
intermingling of Yin and Yang. The rising part (front half ) of the
movement is the function of the organ. It is telling you how the
organ controls and regulates itself. The downward part of the move-
ment (back half ) shows the structure of the organ, its physical aspect.
The first half of the movement is function; the last half is the organ
itself. If you feel that the first part, the upward moving part, of the
movement if wiry (for example) then that indicates a functional
problem. If you feel an out-of-balance movement in the second half,
the downward half of the movement, it’s more likely to be an organ
problem.
Why is this front/back part of the movement important? Let’s

look at some examples.
• Stomach: what happens when you eat? You expect a flood-
ing movement into the Spleen/Stomach sector of the pulses.
You should feel a big movement in the first half because the
Stomach is full and the function of it is at its maximum.
• Gallbladder: let’s say that the 1st half (function) of the Gall-
bladder position is okay but the 2nd half (organ) is choppy.
That would mean that there is potentially lots of bile and
stress backing up in the Gallbladder organ itself. On the oth-
er hand, if the 1st half is tight, it could indicate a Gallblad-
der spasm (function).
• Lung: if the 1st half (function) of the movement is tight it
may mean respiration problems with Heat. While if the 2nd
half (organ) of the movement is choppy, it can be indicative
of Phlegm in the organ itself. A choppy, wiry Lung pulse is
often how asthma looks.
• Heart: when the 1st half (function) of the movement feels
somewhat abnormal it can indicate problems due to stress,
symptoms due to stress. When the 2nd half (organ) of the
movement is choppy, it’s often because of cholesterol build-
up – a physical state of the organ.
• Missing organs: when organs are removed by surgery you
will feel a soft empty movement in the 2nd half of the move-
ment in that organ’s position on the wrist. Why? Because
that’s where the physical organ’s pulse would be but is not
because the organ is missing.
• Constipation: take an LI pulse that is rising normally in the
Yang position but wiry in the 2nd half (the Yin portion).
It can mean that there is some problem with the Yin (or
Blood) in that organ or system. It might also mean that the
LI is dry, that the energy is weak, and that it is not eliminat-
ing waste; it’s stagnated, constipated.
If the situation was reversed and the upbeat was wiry and the
downbeat was normal, it would indicate that the Large Intestine
itself is affected energetically and not able to handle routine materi-
al. The organ itself is the problem rather than the material that the
organ is managing. The difference between these two conditions can
be illustrated by a person trying to lift a box who cannot do it. There
are two possible reasons: either the person is too weak or the box is
too heavy. If the downbeat is the problem, it indicates that the box is
too heavy; if the upbeat is the problem, it indicates that the person
trying to lift it is too weak.
One of the important things to remember about the sine wave

movement is that the volume of the Yang portion should match the
volume, shape, and movement of the Yin portion of the movement.
It begins with Yang and goes to Yin – connecting and circulating
around. But everything has to be even, everything has to be bal-
anced, everything has to be symmetrical geometrically. Imagine it
that way because that’s how the sensation that you feel under your
fingers will start to connect with theory.
It is a fact that life gets interfered with and that disease begins
when there is some sort of interruption in our energetic balance.
When there is some sort of blockage or other disturbance, when
some sort of perverse energy overwhelms the normal movement, the
environment that allows disease to begin and develop is created and
will eventually present itself as physical symptoms. The normal move-
ment that I described above is what you want to create when you
treat someone even when the person has severe symptoms because
his or her body then has the opportunity to change things. It has the
opportunity to rest in balance and restore itself for the time being
at least. Then hopefully, the person’s body can retain that notion of
normal and restructure itself. You are giving the person’s body the
“memory” of balance to use now and, maybe the next time that a
symptom or imbalance wants to present itself, the person’s body can
take over in a newly balanced fashion. It’s retraining of a sort.
Normal is the ideal that you are always looking to create through
your use of acupuncture points. There is never any question about
where you are going with the patient or where they are as you nee-
dle them because you are always feeling for change, feeling for the
normal movement. You are rechecking their pulses as you go. The
normal sine wave is the goal of treatment. Granted, normal is an
idealized goal and not every patient will get there but they can start
to approximate the sine wave and when they do they’ll start to feel
much, much better.
So this is what normal means and I want to reserve the word

normal for this sort of movement. Everything else is pathological;
every movement that is not the normal sine wave is a sign of an out-
of-balance situation.
The ideal pulse is a sine curve that is not excessively flowing

in any given direction, yet it is firmly connected in the tonifica-
tion direction. The basic wave is derived from the line dividing
Yin and Yang in the Tai chi symbol, a sine wave. It represents the
perfect balance between Yin and Yang energies: the movement of
the wave rises and falls with the same angle and energy; the area
contained in the Yang portion is the same as the Yin portion; its
rhythm is without breaks or interruptions; its energies mutually
generate each other. The sine waves of individual pulse positions
will be connected from Qi through guan to cun at all depths, and
flow in moderation. If the flow from Qi to cun is very strong and
obvious, it is probably caused by a pathogenic condition moving
in that direction, along the Sheng cycle in 5 Phases. If this mode
is seen in all the twelve positions (zang and fu depths), but at the
same time there is no continuity between the individual waves,
it indicates that the organs are not communicating between each
other. (From A Brief Survey of the Dong Han System of Korean
Pulse Diagnosis by James Ramholz).
It has probably become obvious that I talk more about pulse

positions than I do about the qualities of the pulse. The important
thing is to really understand the physical space where you are feeling
the movements, i.e., the pulse positions. I am describing a very basic
movement and associating it with space. It’s about the space that the
movement is in – the Kidney position, for example - and the space
that the movement connects to – the Spleen position. You will be
seeing how the movement relates to or flows to the other pulse posi-
tions (spaces) or how it doesn’t flow. All that is important informa-
tion for you.
One of the things that you are looking for is the connection of
the movements between the organ systems. You don’t have to de-
cide whether or not it’s a slippery pulse. What you need to decide is:
“does this feel like a smooth flowing sine wave?.” Normal would be
sine waves throughout. The angle of Qi going down would be the
same angle of it coming up all the way through the positions. The
quality of the first half of the movements would be the same quality
as the second half of the movements. When you get the movement
balanced, the perverse qualities will resolve, disappear. That is why
you don’t necessarily have to worry about deciding whether the pulse
is slippery. Because the perverse qualities go away when the pulses
are balanced. What was perverse energy has been given a place to
flow, has been connected, etc. and now feels “normal.” If the perverse
quality doesn’t resolve then you have information and should make
a note of it. That may be something that you will need to attend to
each time you treat this particular patient until you can get his/her
pulses balanced without feeling a slippery quality. Where the perverse
movement is and whether or not you can resolve it is key. A stub-
born quality is important information for you with regard to what is
going on with a patient.
Ideally you want to be able to see all the connections and all of
the sine waves connecting through each of the jiaos. Perfectly normal
would be the feeling of an even movement throughout the positions
as is shown in the diagram. Is this going to be seen in your patients?

Perhaps not .. not in every position on every level. But you will feel
normal as a gentle, flowing movement throughout the pulse.
To review, the volume in the Yang portion of the movement

should be equal to the volume in the Yin portion of the movement.
The shape and texture of the movements should be the same. That
means they are balanced. If there’s any change at all, if there’s any
deviation from that symmetry, that’s information for you. It is telling
you that the organ is out-of-balance, that it is not communicating
with the other organ systems, and that is the key to finding the cause
of the symptoms.
Let’s talk a little about qualities in terms of this pulse diagnosis

model. If the effects of Heat or Cold are to be recognized, this is
what you need to remember.
Pulse shape Indication

Rounder Warmth, more Yang
Sharper Cold, more Yin
Wider Mucous stagnation
Sharper & wider Heat
Smaller, sharper, & saw tooth Bacterial infection
Smaller & rounder Virus infection
Narrower and thin Dryness
You need to think of these changes (feeling rounder, sharper,

etc.) in terms of the sine wave.
• How does the movement that you are feeling in this patient
deviate from the sine wave?
• How does it reshape the sine wave?
• If you feel that the movement is rounder in the front half,
how is that affecting the second or back half of the move-
ment?
For example, if there’s Heat coming into the system, you might
feel a bigger and rounder aspect to the movement because more Yang
energy has been added into the system. If there’s Cold energy being
forced into the system then you are likely to feel more of a sinking
or tight pattern in the pulse movement. The last half will be bigger.
Cold energy is also sharper and more thread-like than Heat energy.
Cold shrinks down and tightens up. That’s why a thready pulse can
be associated with Cold energy. And when the thready pulse starts to
turn to Heat, it gets quicker and bigger. If there’s a wider movement,
that shows that the energy is slowing down and accumulating like
mucous or Dampness building up.
The most important thing to remember is to look at any of

these “textures” against the background of the normal sine wave.
Study or notice how the Heat starts to change the movement,

how Cold starts to change the movement – how the symmetry starts
to shift away from normal and ideal (i.e. the sine wave).
Remember: All of this information becomes unwieldy only if

you forget what it connects back to: the sine wave, how that looks,
and how the information you are feeling deviates from the sine wave.
If you understand that, if you can keep this in your mind, then the
picture that you sense when you put your fingers on someone’s wrist
will fit very clearly with what’s going on in his or her body.
So actually pulse diagnosis becomes easier because you now

know how to go back to what is balanced. You now know what
balanced feels like and when you don’t feel that, you know that
you have information about what imbalances there are and where
symptoms are coming from. You are able to figure out the energetic
imbalances that are causing the symptoms or unhealthy conditions.
This system is a way of looking at things that fits exactly with what
you are feeling in your fingers. You either feel balance or you don’t.
When you don’t, there’s an imbalance and that is the root of the
symptoms.
Let’s imagine that we start ideally with someone whose pulse is

balanced, normal (i.e., we feel the normal sine wave throughout all of
the positions). But then there is some sort of influence on that per-
son’s state - there’s a change in the outside environment like the per-
son moves to a very cold place or their boss yells at them or they’re
worrying about stuff – their pulses are going to change to reflect that.
Their pulse picture could look something like this:
rather than like the normal, smooth sine waves of a balanced pulse
picture.
But, what should happen after they worry, after they get yelled
at, or after they move? Ideally their out-of-balance picture would go
back to a sine wave to show that their body can adjust. Everything
would go back to connected, everything would adapt, everything
would mix in and be balanced. In other words, after we experience
some sort of event that takes our energy out of balance, our body
should have the ability to take the energy back to normal. THIS
is the goal of treatment ….. to retrain the body, to make the body
remember what it is like to be balanced. Treatment can help the body
remember how to get to balance. We can help the body improve its
ability to rebalance; we can retrain it. Most people’s energetic system
is too weak or already too out-of-balance to have the ability to rebal-
ance itself without our help. Then, after a time of remaining out of
balance, symptoms develop.
Another way of saying this is that a good strong system with

a normal, balanced pulse movement should be able to digest every
perverse energy that comes into that system. The body’s ability to
do that shows that immune function is strong, the nervous system
is strong, the physical structure is strong. Part of the beauty of this
pulse diagnosis system is that you don’t have to know how a certain
protein gets twisted or untwisted. You don’t have to know the nerve
receptor sites for muscle movement. You don’t have to know every-
thing there is to know about hormones. The body is going to do that
naturally when the pulses are balanced. This system of pulse diagno-
sis is a whole-systems point of view from a much higher and broad-
er picture. If you can make everything balanced (i.e., balance the
pulses with acupuncture and/or herbal prescriptions) then the body
will take care of all the physiological details which is actually a huge
amount of details. That’s what homeostasis is all about. The energies
are all mixed together and flowing in a smooth sine wave pattern.
Wiry in the Liver may be typical but it’s not normal. Qualities
like wiry, slippery, feathery, and thready are the energies that start
to show up when an organ becomes stressed. Why do I say that?
Because in the normal pulse everything is connected, everything is
communicating, everything is smooth and flowing; there are no in-
dividual perverse qualities at that moment. Water (Kidneys) connect
with the Liver, Spleen connects with the Lung. Each element has a
connection with the others preceding and following it. It’s when an
element or organ starts to show it’s own picture - that wiry move-
ment for the Liver, the Damp movement for the Spleen, the feathery
movement for the Lung – that you know that there is a separation of
energy beginning. That sort of movement indicates that that organ

is no longer communicating with other organs. It is no longer taking
energy from or sending energy through to the other organs. It is no
longer in connection. It’s sort of isolating itself and becoming more
and more isolated. That’s not good. That is what will cause physical
symptoms to develop and it is that sort of imbalance that you can
rectify with excellent pulse diagnosis and treatment skills.
Chapter Four
A Short Discussion of “Perverse” Pulse

Qualities
Here is a list of the most fundamental “perverse” pulse qualities

that I think you will need. As a basic group, they illustrate a view of
the essential dimensions and types of energies found in all pulses and
fulfill Li Shi Shen’s fourfold criteria of:
Floating & sinking
Rapid & slow.
The Li Shi Shen says that all the pulse qualities are based on
these four principles – floating/sinking/rapid/slow - and that if you
can elaborate on them everything will be clear. But many of the
classic authors didn’t elucidate their ideas in ways that we could
translate into our everyday thinking. Or sometimes, I feel like
they mentioned something in passing and we need to figure it out
for ourselves. These qualities are like that - their meaning, their
definitions may seem to change with different authors or even over
time.
Here we will look at:

• Floating, sinking
• Rapid, slow
• Thready, fine
• Long, short
• Slippery
• Choppy
• Knotted
• Wiry
• Weak
• Cosine
Floating and sinking

Floating and sinking refer to the depth at which the pulse is felt.
A floating pulse is found at the superficial level while sinking is found
deep.
Floating is felt with light pressure and goes away with more
pressure. It moves on the vertical axis of the pulse. Some say it is like
“wood floating on water” or like trying to hold a cork under water. A
floating pulse shifts everything (the sine wave) up.
• Floating may indicate Yang excessiveness due to Wind or
Heat.
• It can mean deficiency that makes Yang “float” because it’s
not anchored by Yin. It has no root. It is on the surface
because Yin isn’t pulling it down. This is a different situation
that Heat is making the pulse float.
• It may indicate that the circulation of Qi and Blood is
focused on the body’s surface to deal with an external
pathogenic factor. Interior circulation of Qi and Blood is
temporarily sacrificed to deal with the pathogenic factor and
prevent it from going deeper.
• Floating can also indicate the body’s inability to hold Qi and
Blood. You often see this sort of pulse in the elderly – their
organs are failing to hold Yin so the Yang is free to float/rise.
• Even though we most often associate the floating pulse with
exterior conditions, it may also be found in people who
are obese (because of deeper stagnation), who have a weak
constitution (can’t hold energy), or in someone who has
severe edema.
• Floating may also be seen in someone who has suffered
through a prolonged illness or severe blood loss.
“A floating pulse seen in enduring illness is cause for great

concern.” A floating pulse in these cases differs slightly from
the floating pulse occurring in external disease in that it is
somewhat less pronounced at the superficial level, and markedly
less pronounced at the deep level, for which reason it is sometimes
referred to as a vacuous floating pulse.” (Fundamental Pulse
Qualities, Jim Ramholz)
So the floating pulse can indicate both Wind (excess of the

environment) and depletion (emptiness of the interior). An example
of its indicating Wind is in patients with high blood pressure because
it may be related to internal Wind movement. Position-wise: if
the distal pulse is floating, it is indicative of perverse Wind energy
attacking the upper jiao. This might be the cause of headaches and
excessive mucus production which obstructs the upper jiao. If the
middle position has a floating pulse, it usually indicates weakness of
the Spleen affecting the middle jiao or can indicate excess of Liver
Qi. When a person has constipation (especially elderly) look for a
floating pulse in the proximal position. Materials in the intestines
need to move down but a floating pulse moves against that direction
in the lower jiao. But remember, it’s not the pathogenic factor that
is the issue. It’s the body’s response to the pathogenic factor that is
important. What resources does the body have and what is the reason
for the disease? We must consider these factors.
The sinking/deep/sunken pulse is found deep, with heavy

pressure. It is felt only at the deep level. The sunken pulse shifts
everything back down and can be found in any position. It is a pulse
that is not expressing or communicating with Yang. There is no Yang
output or expression. A hidden or hiding pulse is an extreme version
of the sunken pulse and is felt at the bone depth.
• It can indicate Yin excessiveness due to Cold energy. In this
case the person may have cold hands and feet, cramping,
spasms, or aching muscles.
• It is generally associated with internal conditions or how the
organs are functioning rather than syndromes per se.
• Sunken can mean that the circulation of Qi and Blood from
the viscera to the surface is weak. The flow is confined to the
interior to deal with an internal condition.
• If the distal pulse is overall sunken it could be chest
congestion, bronchial mucous, cold tightness, chronic
inflammation of Lung or diaphragm or mucous retention is
lower in Lungs.
• If the middle position is sunken it can be cold in the
digestive system, not enough heat circulating there leading

to indigestion, bloating, Stomach ache, diarrhea.
• If proximal position is sunken it can mean Kidney deficiency
leading to low backache, frequent urination, vaginal
discharge, or diarrhea.
Let me make a note on the seasons with regard to floating and

sinking. If the entire sine wave shifts up, it’s summertime; if it all
sinks down, then it’s wintertime. But, no matter what the season, the
pulses should still always be balanced. The Yin and Yang portions
should be balanced no matter where you find it. They should
always be connected. The season would just mean a shift up or
down (floating or sinking) of the sine wave. Remember, the seasonal
energies will affect the pulse but they don’t determine it. It has been
said that in spring you’ll see a wiry pulse that’s uprising but that is an
oversimplification. You might see the season’s whole pattern in the
pulses and if you don’t it means that the body isn’t in sync with the
seasons. So if it’s summertime and all the person’s pulses are sunken,
what does that mean about the quality of their Yang energy? It means
it’s pretty messed up. On the other hand, if it’s wintertime and the
pulses are all at the surface, then the person’s Yin energy or center is
really weak. Because at that time everything should be going down
so it can condense and store. But you still want to see Qi at all levels
(superficial, middle, deep) .... only deep or only superficial is not
normal.
When we move from spring to summer you’ll see a lot of rising,

ascending problems. What happens to the movement from Wood to
Fire during spring? It is accelerated because that’s the characteristic
movement of Wind. Further, if the year is already fire energy but
Water is deficient, then that movement is less controlled, less
balanced, less modulated because there isn’t enough Water storage
going on in wintertime. Therefore, if your patients didn’t take it easy
and store their energy in winter that would be a very tough spring
for them because most of their energy will go to the surface, get into
their nervous system and potentially make them more anxious and
edgy than usual. So if you have a patient who has real problems with
Water or who already has psychological/emotional problems then

they’ll have a tendency for more psychological problems each spring.
Rapid and slow

Rapid and slow indicate the speed of the pulse movement when
compared with the patient’s breathing; the breathing and the pulse
should be coordinated. They are seen on the horizontal axis of the
pulse. Normal is four beats per breath.
Rapid (also called rushing) is more than 6 beats per breath. It

may mean that Qi is arriving without Blood. The flow of Qi and
Blood are out of sync.
• It can mean deficiency of Yin and excess of Yang.
• Rapid can mean that there is extra Heat in the system,
that Heat is affecting the upper jiao, or that Heat is at the
surface.
• Or, rapid can mean deficient Heat.
• Rapid can result from an attack by perverse energy especially
of Heat.
• Rapid can also indicate the presence of extra emotional
energy or hyperactivity (especially if the Qi is arriving but
not the Blood to anchor it).
• You might even feel a rapid pulse at different levels – at the
deep bone level it will be rapid, for example, if it is Heat in
the interior. Rapid and sunken would indicate Heat in the
internal organs.
Slow (also called delayed, retarded, late) is characterized by fewer

than 3 beats per breath. A pulse may be slow system-wide or in any
given organ sector. The body, the organ, the meridian is not receiving
Qi, Yin, or Jing flow fast enough.
• Slow may mean Cold energy in the system.
• It can mean that the person does not have sufficient Yang
energy or deficiency of Yang and excess of Yin.
• A slow movement at the superficial level indicates Cold
energy invading at the surface of the body.
• You might say that the person doesn’t have sufficient Yang
energy or that his/her interior is Cold or Damp.

• Slow and strong is one of the indicators of pain caused by
Cold.
• If you have a patient with incontinence, look for a slow pulse
in the proximal position - depletion of Kidney Yang.
• Or think about acid reflux - if the pulse in the Stomach
position is slow, it means that the proper function of the
stomach is delayed. The stomach may be making acid
but there’s not enough Qi or Yang (functional energy) to
churn or use it to digest the food. The materials for proper
digestion are there but there is insufficient energy to do the
job.
Note: A pulse faster than 6 beats per breath or slower than 3

can be an extremely critical sign indicating that Yin and Yang are no
longer communicating with each other at all.
Thready
Thready or thin feels like a fine thread but it is always perceptible
and it is not scattered. It generally indicates Qi and Blood or other
deficiency even deficiency of Essence. One possibility is that Yang is
too weak to push the Qi and Blood through the system.
Long and short

Long and short are the horizontal dimensions of the wave that
indicate the capacity or the endurance of the movement.
• Long is a prolonged stroke and means good health when felt
in young people. You can think of it as Yang of Yin.
• Long plus wiry can be a sign of Liver Qi stagnation or excess
Liver Yang.
• In younger people, a long smooth movement can be
considered normal.
• Short is a movement that deteriorates as it flows toward the
next position. It strikes your finger at the beginning of the
position and then leaves. The position (horizontally) is not
complete; the energy is not filling the position. It indicates
that the organ’s energy is not strong enough to move into
the next sector. It can also have emotional meanings which I

will discuss later. Or, if it is short and choppy it can indicated
Qi stagnation. You can think of it as Yin of Yin.
Slippery pulse
Slippery and choppy are about texture, not shape.
Slippery: all of the classical descriptions are good for this = feels
round, smooth, and flows evenly; feels like touching oily or wet
pearls rolling on a plate. I’ve even seen it described as feeling like
“small fish swimming” or pushing small beads into a carpet.
• Generally, slippery means Dampness or that Qi is deficient
when compared to Blood. It can be felt system-wide or in
just one position.
• Some say that it can be seen in pregnancy but I will show
you a different way to feel pregnancy later in the book.
• A slippery pulse can mean damaged digestion. Damaged
digestion can be a cause of Qi stagnation.
• Slippery can also mean mucous secretion or a blockage of
the blood flow.
• Li Shi Zhen says that a slippery pulse can happen when yuan
Qi fails and can no longer hold Liver and Kidney fire.
• “Wiseman says that ‘A slippery pulse is commonly seen in
pregnancy, particularly in the early stages where extra blood
is needed to nourish the fetus.” (But again, I will show you a
more definitive way to feel pregnancy.) He further says that
“slippery is also sometimes seen in healthy people, indicating
an abundance of Qi and Blood.”
• If you have a patient with heart disease, he/she can be a
teacher to you. If you see slippery coming toward or into the
Heart position, it can indicate erratic blood flow (including
clotting) or tightening of the arteries. One way to check for
heart problems in specific is to study the flow of energy from
the Liver to the Heart position; is it normal or not?
When the pulse is slippery, the first thing you know is that the
Yang energy is becoming overly active. It sometimes also indicates
that moisture, especially mucus secretion, is excessive. So when the
pulse is slippery, the first two important things that you should think
of are that there might be some activity with the Heat and then you
have to ask yourself if the Heat is caused just by the Qi or also the
xue as well. The quality of the slippery pulse often indicates localized
excessive Heat when it is in one position or in a sector of a position.
It will also be felt when the source Qi is unable to hold Kidney fire
causing Heat at the Blood level.
Choppy pulse
Choppy: has also been called rough, sandy, and dry. You know
how a cobblestone lane feels? Bouncy, bouncy, bouncy. That’s choppy.
It is beating with difficulty rather than an easy flow. Generally, it’s
thin, minute, and short and has an uneven flow. …beating with an
irregular rhythm. Some say it feels like you are running your finger
across very fine sandpaper. The momentum is pushing forward but in
a jerky motion. The forward or horizontal movement of the Qi is not
supported by Yin. It feels as though the energy is having difficulty
flowing - and it is. It basically means that there is a circulation
problem.
• Choppy can indicate a dry condition where Qi is more
abundant than Blood or it can actually indicate deficiency of
both Qi and Blood. Check out the pulses of anemic patients
or those recovering from surgery. The blood loss can lead
them to have a true choppy pulse.
• It can indicate Cold. In the middle jiao (Stomach/Spleen)
position it means that the middle jiao is cold and will be the
case of indigestion, diarrhea, stomach cramps, etc.
• Localized congestion will feel choppy. Feel it when someone
has a sports injury or deep bruise.
• Choppy is where there’s more Yang and insufficient Yin and
that’s what causes the halting sort of movement.
• Felt in the lower jiao it means that the lower jiao is cold
and Yang deficient. This may be the cause of urinary
incontinence, edema (because water filtration is the job of
Kidney Yang), and constipation (especially in the elderly).
You may also feel it here in patients who are receiving
chemotherapy.
• You can also see choppy and Dampness together sometimes.

If there’s a lot of congestion, blockage, and inflammation at
the same time, the pulse will feel choppy.
• Wiseman says that choppy is “a pulse opposite to the slippery
pulse, i.e., one that does not flow smoothly and that is
classically described as ‘a knife scraping bamboo’. The rough
pulse is sometimes termed a choppy or dry pulse in English.
It tends to be somewhat fine, is generally slightly slower than
the normal pulse, and has been described as being fine, slow,
short, dry, and beating with difficulty.’ The rough pulse is
often seen in Blood stasis patterns and dual vacuity of Blood
and Qi.”
Choppy or rough in clinical practice is a very general term and

almost anything that is neither soft nor slippery may be considered
choppy. A choppy (also sandy, rough, or fine) pulse can be a Yin pulse
indicating a Cold syndrome; the rougher it gets, the colder it is. It
is usually found as a Cold syndrome in the deeper area of the body
indicating a circulatory imbalance or poor blood circulation.
Can a patient have a pulse that is both slippery and choppy overall?
Overall? In all positions and at all depths? Not likely. But then
I haven’t seen all trauma or ER cases. But in separate positions or
different depths in the same position, you can see one or the other.
Only someone with poor pulse skills would say that the pulses were
overall only one thing. It is a generalization so sweeping that it
becomes meaningless.
We can become much more specific in our diagnosis than saying

that everything boils down to either Spleen xu, Liver depression,
or Blood stasis. There are large areas of TCM, like pulses, that are
ignored or go underutilized only because we want to imitate what the
Chinese are doing today rather than doing what is possible. If you
can diagnose an identifiable pattern in the pulses for specific diseases
using the Nan Jing, Mai Jing, and other methods---for example,
if you can identify tumors, MS, or emotional disorders that are
creating physical problems, etc.---you can measure the successfulness

of a treatment in how those pulses respond.
Knotted
In the previous pulse patterns, there was always an implied
connection or reference to a balance. In the knotted movement, the
symmetry of the Tai chi model is completely broken. (from On The
Li Zhi Shen’s Pulse Diagnosis by Jim Ramholz).
Knotted (called binding by some) is a shape in and of itself. It is

usually described as a hesitating movement. The movement comes
up, hesitates or holds, and then goes on toward the next position.
Another way to think about it is that the movement swells, crests,
and then stops and spins. The spinning is an indication that energy
is concentrating and creating a blockage. It doesn’t occur with every
pulsation so is considered irregular. Here is where I disagree with the
usual description: the knotted movement does not move on toward
the next position. It is stuck in one position. This is caused by
obstruction of some kind.
• Knotted is a sign of energy blockage.
• Found in the superficial level indicates an emotional block.
• Knotted can indicate perverse or excessive Yin coagulation
in the form of clots, tumors, mucous, or cancer. In fact, if
it happens during every pulsation, it can mean a tumor (a
stagnation, cancer) that is in one place.
I’d like you to consider what is actually happening in the

knotted movement. As the movement comes into the position there
is a portion of it that doesn’t go forward. It comes into the position
and spins in place. Or sometimes, in the case of tumors, it spins

or vibrates in space, in the same space. It does not move forward
into the next position. It is “stuck in space” without a descending
movement. Remember, the first part of the knotted movement is the
upward rising movement of Yang. This upward movement that is
stuck in space is what a cancer movement feels like. The movement
basically represents out of control growth of energy.
What is the clinical significance of the quality of knotting?
The basis of the knotted movement is stagnation, stasis. It can be

a tumor movement, a movement spinning in space. In a cancer pulse,
we can see a very strong growth or Wood movement but no Metal
or controlling aspect. If the person has bone cancer, you will see it
(the knotting movement) at the deepest level of the pulses of the jiao
where the cancer is located. Sometimes bone cancer spreads back in
the spine. Or, as it did with one of my patients, ovarian cancer may
metastasize to the spine. Look in the left proximal position for lower
lumbar and sacral area, in the middle position for thoracic vertebrae
between the diaphragm and navel levels, and in the distal position
for vertebrae above the diaphragm. If there are multiple tumors, each
tumor will have its own knotting movement. Breast cancer shows
up as a binding or knotting movement in the right distal position at
the Spleen and/or Heart depth since the Spleen channel is physically
located there and because it is a problem that manifests in connective
tissue and superficial muscle. With cancer, the TaiQi circle between
left and right sides is irrevocably broken.
If the pulse knots with every beat, there is something physical

going on; there is a physical presence of a tumor perhaps. One of
your best teachers is a patient with cancer. You can learn so much
by feeling his or her pulses throughout diagnosis, treatment, and
post-treatment. In the pulse, if you see a knot in the middle depth
it means that the organ has cancer. If it’s in the superficial depth,
cancer may be starting to form in the organ. If it is felt in the deep
depth, the cancer may be moving on (metastasizing). Remember that
the pulse reading is only valid for active cancer. If there is no current
cancer activity, like in complete remission, you will not find a knotted
pulse.
A note about tonification and cancer: While there may be a

danger of tonifying the cancer, you can do some tonification on your
patient. The first rule in the acupuncture treatment of cancer patients
is that you need to be mindful not to tonify any channel that directly
leads to where the tumor is as it therefore may promote its growth.
In the case of prostate or bladder cancer for example, you would
not tonify Sp. 6. In fact, you would sedate it to inhibit the cancer
movement since all three channels have connections that feed into
Ren 1. Or, you could tonify LI 4 deeply to send down vital Yang Qi.
If you just feel the knotting movement one time or it happens

irregularly when you are feeling the patient’s pulses – you feel it
once in a while then don’t feel it – it is likely a stasis, obstruction,
blockage, phlegm node, or deep bruise. It is something physical and
hard so the Qi and Blood can’t get through. But when the movement
starts to stay in space or condense in space and it looks like the
diagram above, that’s a more advanced form of the knotted pulse and
can be a tumor. The movement is very localized. You will see that sort
of movement somewhere specific, in the skin, the bone, the Liver.
I had a patient once who developed bone cancer that had started
with breast cancer. She didn’t want to do any Western medicine. She
refused to see an oncologist. She thought her good intentions were
enough but the cancer didn’t believe her. She got bone cancer; her
vertebrae started to fracture. The tumor sites were at T12 and T6. In
this case, when looking at a very small site you will feel a very small
energetic movement in the pulses at the bone level at where T12 and
T6 are along the spine. The tumor site itself, not the metabolism
or the body’s reaction to the cancer, will show this sort of knotted
movement. It comes into the position and spins in place. What’s
going on is that cancer is a growth of cells in the organ or bone. The
pulse is supposed to flow like a sine wave but instead it forms a knot
and that knot is the metabolism of the cancer movement adding
itself to the organ movement or to the energy site. Under your
fingertips it feels like knot, knot, knot in one spot. It doesn’t move.
It’s one wave building on another wave. The cancer movement has
a huge amount of metabolism and energy and growth but there’s an
energetic ceiling and you feel it: the knot. The movement comes up
and tries to go higher but it can’t so it just builds and spins and knots
at that point where the cancer is. It’s a stuck energetic movement,
so much so that sometimes it even bounces back and forth like the
“spinning bean.” And it’s aggressive. If you see it big and in a whole
jiao, the jiao is stagnated, blocked. But if you see very localized – it
can mean a tumor or other solid coagulation.
What if the movement hits then pause, pause, pause hits then pause,
pause, pause?
That’s probably excessiveness and a lot of Heat and/or Phlegm

building up in the system. The hesitation is stagnation building up
and the energy builds up against it before it goes on. If we’re looking
at the whole movement and you see that it’s systemic, it could be
a metabolic problem being created by Dampness or Phlegm in the
body. When it’s localized, and that’s the advantage of doing this sort
of pulse diagnosis where you can identify and see the influence of
localized things going on, …. then you know it’s a tumor, clot, cyst,
fibroid, something like that. One thing you must consider when
feeling for tumors/clots/cysts, etc. is that whether or not you can
feel it is an indicator of how many cells are there – how strong the
cancer is before it gets noticed. Nobody can see the cancer building
up when it’s very tiny, but when there are thousands of cells, it can
be felt. Another way to put it is that there is no pre-cancerous pulse;
there must be cells built up in order to feel it. The knotted movement
of a tumor doesn’t go away. It’ll come up and you’ll feel it over and
over. It comes up and spins, up and spins in place, in one place, a
strong spinning movement building in one place. A knot is actually
energy condensing and building into a particular site just like a little
tornado.
Do you concentrate on the surface level if the tumor is just

beginning and there’s a big emotional part?
You have to distinguish between all the metabolic and emotional

things that helped create the tumor and work on the tumor site itself.
The knotted movement is your feeling the tumor. Take uterine cancer,
for example, where you’ll see a movement from Liver shooting back
right into the Kidney position with a knotted movement. The Liver
stress is going through the internal pathway down to the uterus. This
is the tumor site and this is the pattern that shows the development
of the uterine cancer.
What about chemotherapy and the pulses?
Chemotherapy often causes a sort of mild Kidney failure or

certainly a burden on the Kidneys because they have to filter out
the chemotherapy toxins. So the Kidney pulses might feel soft or
scattered. You have to pay attention to this because the other pulses
are liable to feel full and active due to the toxic Heat. A weaker
or soft Kidney pulse is one of the essential details of dealing with
cancer patients who receive chemotherapy. The earlier our effort
is to save the Kidneys and Liver, the better and more effective the
chemotherapy becomes. You can sedate the Heat in the Kidney by
tonifying the Water and Earth elements. This will provide stronger
mucus and body fluid secretion. This is one of the few situations
where you intentionally tonify mucus secretion. If not done, chemo
and radiation therapy can burn out mucus membranes.
If you feel this sort of movement but not every time, or

you would describe it as going back on itself, that irregularity or
inconsistency of the movement shows that it’s not a cancer tumor. It
may be a phlegm node or something building up and obstructing.
The movement means that the organ is so congested that the energy
coming in just bounces off because it’s too full. It’s like trying to pack
more phlegm and inflammation into the Lung and you can’t do it.
Back and forth or counterflow in a position
We talk about back and forth in the Spleen/Stomach position

indicating worry. What else can it mean when the pulses reverse
from the cun location towards the Qi location? It can mean that
the related Back Shu points are blocked. Since the organs are
not communicating through the Back Shus, they will be blocked
internally. Most of time, venting or unblocking the Shu point will
remedy the organ stagnation.
Wiry or string pulse
This pulse feels tense, tight, stiff, or thin and tightly stretched
like a bow string or tight guitar string. It’s a pulse without flexibility;
there is no wavelike sensation. It is usually thin rather than wide and
short rather than long and feels strong; some call it urgent. When
you feel this, I often say that Qi is not flowing very well; we need to
move it; we need to move the energy along like a river needs to flow
rather than stagnate. Yin and Yang are not dispersing, which can be
due to stagnation, exhaustion, or pain. The wiry pulse is most often
associated with the Liver and Gallbladder and it is true that you
can often find it in that position. But, it can be found in any pulse
position. It is often associated with pain (especially severe pain),
hypertension, hardening of the arteries, and chronic lung problems.
Sometimes you feel this in someone who is completely exhausted
because they can’t absorb, store, and move Qi.
To resolve a wiry pulse in the Liver position, you can treat the
Liver and/or Gallbladder channels or tonify the Stomach/Spleen
-which will need tonification because the Liver frequently attacks
those organs. And, when the Spleen/Stomach system is damaged,
our nutritive support is interrupted which can then lead to immune
system issues.
Let’s say that you also feel like the wiry pulse is also slippery
(or what I call thick). This can mean there is too much Heat in
the system. A wiry Liver pulse can mean there is tightness in the
diaphragm which will affect the Heart and digestion (Spleen/
connective tissue). Because of the decreased flow, the wiry pulse
leads to deficient, passive, and negative Qi flow which may engender
Heat - really false Heat right? There isn’t a pathogenic Heat. The Heat
is created from within by stagnation or passive energy flow. Wiry

in the San Jiao indicates nervous tension and/or exhaustion of the
nervous system. If the upbeat (Yang) portion of the wave feels wiry,
it indicates that Yang energy is tense while Yin is not. This person
might be very emotionally reactive but the organs aren’t affected yet
(becasue the Yin part of the wave is not wiry). Frequently, especially
when felt in the Liver position, the pulse is said to indicate a Wind
condition. But, even when you find this type of pulse with Wind
conditions, you must think about deficiency and organ sensitivity
(due to stress) rather than what the classics would call a true Wind
condition. And, if the wiry pulse is found in the Heart position, the
Heart may be tense, deficient, have reduced capacity, and therefore
palpate faster trying to compensate.
Weak, deficient is an empty, forceless feeling movement; similar

to fine but softer.
It can mean Qi and Blood Deficiency.
All the definitions or words that are used to describe pulse

qualities were created for the generalized, whole jiao descriptions.
Using this pulse diagnosis model you will have the ability to gather
much more specific information than that.
Just knowing the above qualities, along with knowing what a

break in symmetry feels like, and how that change is showing you
the lack of symmetry between Yin and Yang, will allow you to figure
out anything, anything. This pulse diagnosis system is an application
and development of classical theory – it has all the elements
of classical theory – but the application is now more and more
expanded. Your abilities will expand with practice just like when you
start playing a musical instrument. Take learning how to play the
piano as an example. You can do the scales and play really simple
tunes but owning the sheet music doesn’t make you a musician.
Practice makes you a musician. And with practice you can play rock
and roll, classical, jazz, whatever genre of music you want because
you know how to shift “models” if you will. You still use the same 88
keys but have a shift in your musical model. The same thing applies
here with pulse balancing; you can take all the classical information
about positions, organ function, interrelationships between Yin and
Yang and use it to become much more able to determine the causes
of disease.
One treatment for weak pulses is to put moxa on SJ 4.
Cosine movement: the last movement that I’d like to talk about
is the cosine movement. One way to look at the cosine movement is
that it shows that the energy is 5 elementally (5E) reversing in that
element. If you see that in more than one position it means that all
those elements are starting to reverse. The 5E connection between
Mother and Child is breaking down.
Kidney Sp/St Lu/LI
Notice that the movement starts with a dip rather than starting
to rise up as we expect Yang energy to do and that it does do in a
normal sine wave movement.
You will see this sort of reversal (cosine) fairly often. You won’t
see it necessarily by itself, there will be other things going on in other
sectors of the pulse. Let’s say that you see a cosine movement in
the Liver position. That’s how depression feels. A cosine in the Liver
position is the energetic signature of depression. Think about what’s
going on: a cosine movement is the exact opposite flow as the sine
wave (the normal pulse). One way that the body compensates for
depression is by over-using Kidney function. If you’re depressed, you

can’t grow; you can’t expand because of where that effort begins. The
energy that funds that out-of-balance movement in the Liver comes
from the Kidneys. You will see the cosine movement in depression
begin with a sinking feeling deep in the Liver position that rises
toward the Heart position. The depression movement that I am
describing here is a demonstration of how you will be able to see
what the body does to compensate for chronic emotional patterns.
In this case, the body’s Kidney function is being “sucked away”
by the energy of depression. So instead of a healthy upward Yang
movement coming from the Kidney position, you see a low energy,
sunken movement that rises up toward the Heart. Further, the rising
movement may feel wiry because the Liver is out of sync.
You will see the cosine movement fairly frequently in the

Liver and Spleen. What do you think is going on when you see
it in the Spleen? The Earth element has to do with thinking and
contemplation but also with nurturing in the sense of feeding
ourselves. So it is possible that when you feel a cosine movement in
the Spleen position, the person is not being fed emotionally. It could
be conscious (felt at the top/superficially), it could be semiconscious
(felt at the middle level), or it could be unconscious and adapted
(felt deep). Often you will see the movement as unconscious and
adapted. You will put your fingers at the top and when you press
down it’ll feel like the whole center (the Spleen position) just caves
in. It will feel like a deep hole. It may even be a movement that you
can feel pulling down. This is an indication that the patient is deeply,
emotionally needy. The movement is like a little mouth sucking,
sucking for energy and there’s nothing there. It’s like a child crying
out – and that’s probably how it started – a child crying out for
nurturing that didn’t come.
Do people express this sort of deep, emotional neediness?

Sometimes. But to publicly express this sort of need to be nurtured
is considered pathetic, unsocialized behavior, so people don’t usually
show it. They just keep silent about the fact that they don’t feel loved
or nurtured. And, they can’t even do it for themselves. But that
doesn’t mean that the need isn’t there, that it isn’t going on, and that
it isn’t affecting their system. This is what is important for you – you
know that this deeply deficient Spleen energy (possibly due to lack
of nurturing) is negatively affecting their physical health and you see
this in their pulses. Remember, the Spleen/Stomach/Earth is in the
center of everything. Everything connects and transforms through
the Spleen, the Earth element, before it transforms into the next
element. Spleen, or Earth, has to do with the intake of energy and
the production of energy, the production of Qi. There should always
be a connection through Earth.
Earth element is in the center. It is in the center of the middle

jiao and has central importance. As you know, when we look at
and talk about systems in TCM we frequently match Earth with
another organ to see what the functional level of the system is.
When we look at Earth and Fire to see how they work together,
how they communicate, we are looking at nervous system. When
we look at Earth and Metal we are looking at the basis of our
immune function because Lung has Wei Qi and Spleen has white
blood cells. Earth and Water are the endocrine system in general,
its functioning and communicating and where we might look to
determine whether or not it’s sufficient or insufficient. So Earth has
a central importance. The reason that knowing these relationships
is important is that when you feel imbalance or a cosine movement
in Earth/Spleen it can mean that the person can’t nurture him or
herself. The person runs out of Qi; runs out of energy; Earth doesn’t
coordinate everything; and since Earth is involved in immune
function, the person’s immune function may be compromised.
Now that we are reminded about the importance of healthy

Earth function, let’s review what causes problems for Earth: over-
thinking, ruminating, overwork, bad diet, recurrent infections,
stress = the American lifestyle. Jim used to say that the Earth/Spleen
imbalance is job security for us.
Chapter Five
The Pulse Positions/Organ Locations
The pulse locations were determined in part through a 5 Ele-

ment method for distinguishing the center, left, right, bottom, and
top. They weren’t developed solely by figuring out how Yin and Yang
flowed through the positions. Once the 5 Element locations were
decided – they more or less matched to the upper, middle, and lower
jiaos but not exactly. The positions in this model are the same that
most of us learned in TCM school:
Position Left Right
Cun Imperial Fire Metal
Guan Wood Earth
Chi Water Ministerial Fire
When you think of 5 Elements, the first association I want

you to have is phases of energy, especially when we look at pulses
and are looking at problems in the organs. The movement that rises
up is Wood. The movement that expands across the surface and
evaporates is Fire. The movement that comes down again is Metal
and the movement that comes back to the center and condenses or
crystallizes is Water.
Wood rises and moves. A movement that rises or moves is Wood

or Wind.
Fire disperses, lifts, spreads across the surface lifting everything.
Metal brings everything down. Breathe air into the Lungs, it

comes downward into the Kidneys to crystallize to create Jing.
Water seeks its own level or condenses to a spot.
Try to break your chain of association with 5 Element just

pertaining to one organ. Each organ will have a predominance of
that element but is not necessarily the organ itself. In other words,
when you think of 5 Elements think of a system of movement.
Don’t think of just the Liver, just the Heart, Kidney, or Spleen but
movement because this is what you are going to see in the pulse –
the movement of energy to energy – Water to Wood, Wood to Fire,
etc. The positions/organs correspond to the 5 Elemental movement
through the tonification and sedation cycles – the flow from Qi
to cun, left to right. Start with left Qi – Water creates Wood that
generates Imperial Fire. Then, because there are two types of Fire in
the 6 Energies theory there’s an interface of theories here. You see
Ministerial Fire in the right Qi position that generates Earth that
generates Metal and thereby completes the cycle.
This is where feeling the movement through the pulse positions

originates. You are feeling the energetic movement through the
tonification cycle. Further, since the pulses on the left side are the
controlling (or sedating) elements for the right, the left pulse may
feel slightly stronger than the right in some people but this is not
necessarily a rule.
On the left, from cun (proximal) to qi (distal) we have Kidneys/

Kidney Yin to Liver/Gallbladder to Heart/Small Intestine. On the
right side, from proximal to distal, we have Kidney Yang to Spleen/
Stomach to Large Intestine/Lung. The left proximal position is also
prostate and uterus. The right distal position can also be bladder,
adrenals, Mingmen, central nervous system, San Jiao, and the brain.
Left Proximal Pulse, Kidneys, prostate, uterus, Water

The kinds of pulses that we will most often see here are related
to the Kidney energy getting weaker and this can cause concern
about a variety of issues. In class I say that “you’re not going to feel
a strong Kidney pulse. By the time people are in our offices they’ve
usually had symptoms or an illness for so long that their Kidney
energy has taken a hit.” So we can’t base our pulse diagnosis on “weak
Kidney energy” alone; we need to look at the relationships with the
other organ systems. And, we must consider a general Yin or Yang
deficiency as well. So most of the time the Kidney pulse is going
to be a little thin or a little soft or a little weak. That is much more

common that a strong or excess pulse here. If for example, it’s a little
thin and tight but most functions are normal, it might just be that
the patient is tired.
Examining the pulses at the deep level in the beginning (that is,
starting out with deep pressure) allows us to measure the overall core
Qi/Jing/Original Qi/Mingmen of the body. You can think of this as
comparing the left Kidney (proximal) pulse with the right proximal
pulse - the San Jiao. It is akin to comparing Kidney Yin with the
nervous system. If they are both the same, then the Original Qi level
is about the same as Kidney Qi. However, if the San Jiao pulse (right
side Kidney position) is overactive and the Kidney pulse on the left
seems muted, then the capacity of the Kidneys is diminishing. The
San Jiao is overworking and the Kidneys are underworking. This sort
of pulse reading is a sign of mental stress.
Sinking here will be characterized by symptoms like weakness

in the low back or low backache. Weak means Yin, Body Fluids,
and/or Blood deficiency including in the uterus or vagina which
we see in peri-menopause and menopause. Slow means Cold in the
Kidneys and/or Bladder can cause an abundance of clear urine, back
pain, and spermatorrhea. Weak and/or slow will cause symptoms like
eyesight problems, bone or body aches, tinnitus, feeling cold all the
time (can’t make enough Wei Qi) or feeling too hot because Water
is down. So either feeling hot or cold can go along with Kidney
deficiency. Further, because the Kidneys support the Lungs, weak
Kidneys can lead to weak Lung function and the person may become
very sensitive to weather changes (think migraine headaches that are
related to changes in weather).
The hollow/green onion stalk type pulse is basically a feeling of

empty Yang. That is, you can see that there is some Yang to the pulse
but it’s empty inside. So the Kidney has some Heat but it’s deficient.
There could be a vaginal or bladder infection (UTI), especially if
the movement, sensation is at the deep organ level. That means that
there is something wrong with the organ - and the kidneys, prostate,
and uterus/vagina are found in this position. Slippery may also be

indicative of some sort of infection; there may be yellow or dark
yellow urine. Floating here would indicate Heat and the patient may
have some sort of chronic inflammation.
Let’s say that you feel like the person has a “big” Kidney
pulse; it feels “expansive” to you. Well, the Kidney is both a Yin
and a Water organ and it holds Yang in order to be vital and help
the Lungs create Wei Qi. The Kidneys may be holding Yang and
therefore feel “expansive.” This feels like an excess Kidney pulse but
not in the sense that we usually think of as excess. It can be a sign of
bladder infection or back pain or sciatica so check with the patient.
But generally, this sort of feeling is expansion without a center or,
another way to say it is Yang without Yin, Jing, or Blood so therefore
indicates deficiency. The Kidneys are about both Water and Fire. Yin
and Yang meet in the Kidneys and the Kidneys are the storehouse of
Jing. So if there’s not enough Water then eventually there will not
be enough Fire. A thin Kidney pulse has more of a chance of being
“normal” than a wide or otherwise excess Kidney pulse.
Wiry here can indicate tension in the lower jiao or edema in

the abdomen and/or legs especially if the Liver is also wiry or tight.
If the Liver and Kidney pulses are tight together, then both Water
and sinews are not well controlled leading to edema. Tight or wiry
can also mean abdominal pain, pain on the sides of the body, and
backache.
Left Middle Pulse, Liver and Gallbladder, Wood

The Liver sector is one place where you find depression and
anger and at different levels. There are a few names for the pulse
movements or textures that indicate deficiency: weak, sinking, soft,
hollow/green onion stalk. Weak indicates deficiency. No Liver energy
means no growth, no movement, leading to frustration. But, without
the proper energy to express anger it is going to be stuck inside. A
Liver deficiency pulse can indicate eye and vision problems including
cataracts, and atrophy of muscles. Sinking is also a sign of deficiency
that could be deficiency of Blood or Yang in and around the liver,
stomach, and entire middle jiao. Soft would mean that there’s not
enough activity of Qi and Yang in the Liver. Symptoms can include
anemia, dizziness, muscle pain, and neuralgia. We know that the
Liver stores Blood and the hollow pulse indicates Blood deficiency,
anemia, reproductive issues, and other common symptoms associated
with Liver Blood deficiency.
Slippery indicates Heat in the Liver that can lead to eye

problems, headache, and gallbladder issues. It means Yang expansion
can even indicate physical liver disease. Check the other organs to
see where the Liver might be sending Heat. Tension in the middle
jiao will show up in a wiry pulse but if it’s in the deep, organ depth,
then perhaps the liver is spastic. At any rate, there is stress in the
Liver energy. Muscles may be tight, there may be tension in the jaw,
shoulders, and neck. TMJ can be related to this pulse picture. If this
pulse is felt mainly in the superficial sector, then it’s more emotional
stress, but as it goes deeper it goes into the muscles. If tension in the
Liver affects the Spleen (digestion) and the deeper Spleen pulse is
affected, there can be pancreatic involvement. A large percentage of
people who have diabetes or other blood glucose problems also have
TMJ.
The Liver is responsible for the smooth flow of Qi and absorbs

stress from the other organs to support them and detoxify the
system. On the other hand, when the Liver is in an excess state, it
will send stress to the other organs and parts of the body. From there,
after the muscles get overwhelmed, the stress will go to the Spleen or
Kidneys next because the Pericardium protects the Heart so it will be
the last organ affected. This sort of cycle can be the underlying cause
of muscle pain, stomachaches, back pain, and reproductive issues.
Since the Liver can negatively affect the other organs, it is important
to figure out which channels are affected. Some people actually feel
like they have a mass in the hypochondrium because of the excess
Liver stagnation.
If the Liver is excessive and going to the Heart position, you

will want to clarify if there is involvement with body fat. Check the
Spleen pulse for dampness. If there is Spleen damp entering the upper
jiao you might ask about high cholesterol, hardening of the arteries,
or other cardiac problems.
The Gallbladder: its excess can affect its entire channel. It may
cause headache, migraine headache, and neck pain.
Left Distal Pulse, Heart and Small Intestine, Pericardium,

Water
Note: Elsewhere, I have mentioned that the right proxi-
mal position can indicate Pericardium. However, if you want
to see the action of the Pericardium as an organ, it is easier to
pick it out from the Heart (left distal) position. If you try to
pick it up at the Mingmen (deep right proximal) you may get
confused with other indications. Sometimes when you read
the Heart pulse and it looks stressed, it might not be at the
Heart but rather the Pericardium. To make sure that it is the
Heart stress, you must check all the three depths of the Heart
pulsation. If the problem is only in the superficial depth, it is
probably not the organ being affected. The pulse of the right
proximal does not really represent the Pericardium; it is more
representative of the general endocrine state. At the same time,
you have to remember that the endocrine fluctuation is im-
mediately related to emotional fluctuations. As we know, the
control of emotional fluctuations is one of the functions of the
Pericardium.
If the heart pulse is slow, it is deficient. If it’s weak the Blood

and Yin might be deficient. The sinking Heart pulse can mean blood
circulation has slowed down due to weak Yang Qi. Therefore, the
deep pulse might be considered to be a sign of the patient having
high blood pressure. This is contrary to what we’re usually taught
in school. With high blood pressure the pulse that will be strong is
the Liver pulse; it will thrust Yang to the Heart but the Yin doesn’t
follow. Therefore, the Heart pulse is still thin or deep. This situation
causes strong, what might be damaging movement, to affect cardiac
arteries. Dizziness may also occur.
An attack of Wind may make the Heart pulse feel floating as

well, indicating Blood deficiency. Chest congestion or Heat can
make the Heart pulse feel excessive and/or slippery. The excessiveness
means that the Heart is working harder. The Heart, Liver, and the
Spleen are partnered in the production and utilization of blood. So
Heart pulse abnormalities call for a look at the Liver and Spleen.
Another way that you might see Heat in the chest is if the Heart
pulse feels wide or expansive.
Right Proximal, San Jiao and Mingmen, Water

The right proximal pulse is sometimes defined as Kidney
Yang, lower abdomen, pelvic area, San Jiao, Mingmen, brain.
Which is correct? Which do we standardize on? Which authority
do we follow? Different authorities have emphasized different
interpretations at different times in history. The contemporary
“accepted interpretation” eliminates most of those. The answer is
that, in contemporary clinical practice, any one of them, or even
several in combination, are correct. The truly correct question here
is “When is it any particular one of them?” I’ve seen patients who
exhibit them all. In this system, we know how and when to use them
all.
At this point you might be saying to yourself: “wait a minute

….. how can one position be all of those things, Kidneys, uterus,
prostate?” You will be able to see and understand and decide whether
it’s one or all of those things because you will be looking at the
whole context of the pulses. If you only look at one jiao you’ll never
be able to figure it out. Those definitions where it says that this is
San Jiao, this is Kidney Yang, this is Small Intestine, this is the lower
abdomen – all of those depend on the connection, the interaction,
and the relationship to the other jiaos, to the other pulse movements
that you feel in order to determine where the imbalance lies. That’s
why it’s not really a controversy. It’s just that people have a different
perspective because they only know how to look at a little bit at a
time. You have to look at more than one position, more than one
jiao. Pulse diagnosis is about the entire picture not just one position
or one organ.
I’m certain that you have read various classical interpretations

of what the San Jiao and Mingmen are. Basically, the San Jiao is
the nervous system including controlling the three jiaos, and the
Mingmen is the endocrine system. Another way to think about
them is that the San Jiao is kind of autonomic (cardio-respiratory
system, digestion, urogenital) while Mingmen is more Fire element.
Take advantage at looking at the San Jiao when considering how the
nervous system is functioning. You are familiar with talking about
the San Jiao in terms of how Qi is flowing through the jiaos or
whether something like Heat is stagnating the jiaos. Well now, think
about it in terms of nerves/nervous system/“nervous” conditions.
For example, if a person is feeling anxious, his or her San Jiao pulse
might feel wiry. You could think about that like “nerve-heat” if you
want to stick with the usual and customary TCM or old fashioned
way of thinking about the pulses. Another way to use the San Jiao
right proximal pulse is to see how mentally tired the person is. If the
pulse feels active then the person’s mental agility is strong; if it feels
tired or weak then they may be mentally tired. An empty San Jiao
position can also mean that physical energy is very low.
Let’s look at San Jiao as Yang and Mingmen as Yin, a functional

pair. The endocrine glands (Mingmen) are involved with hormones
(Yin/substances), while the nervous system (San Jiao) is the
communicative organ that uses electrical activity (Yang/function).
We are used to talking about the Mingmen as being located between
the Kidneys and as being activated by San Jiao function or mental
activity. But, when you look at the adrenal or other hormonal
functioning in the pulse you look in the Kidneys (Mingmen).
Mingmen can be seen as a way to study the overall balance or
imbalance of the endocrine system.
Yet another way to look at it is that the Mingmen and San Jiao
are broad indicators of overall function of Jing/hormonal system and
Qi/mental/nervous system/brain. Each looks at the whole system
with which they are related. That is, you’re not going to be able to
determine whether a person is depressed (mental/nervous system/
brain) without looking at other pulse movements. If the Liver and

the San Jiao are wiry, the person may be angry. If the Spleen and the
San Jiao are communicating, usually by the San Jiao sending Qi to
the Spleen and the Spleen sending it back, that is usually worry. Jim
also used to call this the boyfriend-girlfriend pulse - so check to see
if the person is in love, trying to be in love, or missing someone that
she/he loves. NOTE: The Spleen/Earth sector is about nurturing
right? So this makes some sense.
So as you can see, in the pulse, the San Jiao has diverse
functions. Like other pulse positions, these functions can be clearly
distinguished when it (the SJ) interacts with other pulse positions.
San Jiao represents the nervous system, so when we want to see
whether nerve tension is high or low we first check the San Jiao. If
the Qi in the meridians is flowing with good thrust the pulse will
pick up. If the San Jiao pulse is low, the meridian Qi flow is low. San
Jiao is a general barometer for the meridian energy and, through its
physical placement on the wrist, shows the lower abdomen from the
front. So, when we compare the San Jiao pulsation to Kidney (left)
we can check the general level of the Dantian energy.
The brain:
You can also see that, when we look at the San Jiao as the central
nervous system, we are looking at the patient’s brain activity, the
activity of his/her mind related to the nervous system. We can look
at how much their emotional stress is adding to the central nervous
system and what kind of burden the nervous system is under. This
is how to conceptualize the San Jiao as the central nervous system.
San Jiao is in the perfect position to be used as an indicator of upper,
middle, and lower jiao activity, how well heat is being distributed;
and how the central nervous system influences the body.
For example, I tell you that you can treat the brain using the
Du Mai, Gallbladder, Kidney, and San Jiao channels. In school, they
might have talked about the GB meridian and the superficial flow of
Qi, that it’s more about the surface, the external not the deep organ.
And that might be true if we are talking about the Gallbladder
organ. With regard to treating the brain the classics talk more about
the Kidneys not Gallbladder. Jim taught me to think about the the
GB channel as a sort of antenna. It is close to the brain and can pick
up what’s going on there and therefore treat that area. It is not a one
to one correlation because you are picking up something through
the Gallbladder and/or the San Jiao channels (because they both go
on the side of the head). Their connection (via location on the head)
isn’t only to what’s going on at the surface, they pick up information
from the inside too.
Part of what goes on with the brain is that the brain gets
nourished through Life Gate/Mingmen. So if someone has
something like Alzheimers you’d look at San Jiao and Kidneys.
Kidneys are supplying the San Jiao in order to replenish the marrow.
But you are also looking at San Jiao to see where the activity shows
up. For example, in schizophrenia, you will see not one movement
coming out of the San Jiao but several because different parts of
the brain are manifesting irregular movement. You must look at
the whole context and part of the context is the meridian activity
going on and the metabolic activity going on. The same way with
the thyroid. If you see a goiter, you can look at what’s going on
energetically – then check adrenal function to see what’s going on
metabolically. It might feel something like water hitting a wall in the
Stomach pulse position. This is the anatomical position of thyroid.
You can also feel it at the end of the LI position. Remember, we look
at the thyroid from the point of view of the meridians. In a person
with a node near ST 9, it will be clear on the right side because it’s so
close to the Stomach channel point that it’s influencing the flow in
the Stomach meridian. But at the same time it’s not changing thyroid
function too much so the person may not have symptoms - but you
will be able to feel it in the pulse.
We are used to saying things like “Liver and Gallbladder”

and that gets us making associations that are not always correct.
When you say the Gallbladder meridian you are actually looking
at Shaoyang energy (Gallbladder). Shaoyang energy is very close to
nervous system energy. It’s like vital Qi; like Universal Vital Qi …
so that’s another reason why Shaoyang is very close to neurological

activity. So when you’re needling Gb39 for marrow, you are actually
stimulating marrow production because of that Shaoyang/nervous
system connection.
As far as picking up things like tumors in the pulses, look at

where tumors are in the body. For example, if there’s a tumor in the
eye, where would you expect to see it? In the Liver position in the
sensory range of the Liver position (the top third) because that’s the
part that is connecting with the eye.
Traditionally, the right side Qi position is San Jiao or Kidney

Yang and left side Qi position is Kidney Yin. But you can also see
Large Intestine information in the left Qi position, and it’s possible
to see Small Intestine information on the right side in the Qi
position. Why? Because those organs are physically located in the
lower jiao and the Qi position can represent the lower jiao. Think
about how the positions are organized classically: Small Intestine is
on the left side distal position at the surface and the Large Intestine
is on the surface in the distal right position. Were the ancient masters
confused? Those jiaos are in the wrong positions for those organs.
That is, those organs are not located in our upper jiao. So what are
we looking at when we’re taking the pulses there? We are looking
at the surface of the body. The Large Intestine meridian is at the
surface, right? It starts at the finger and goes to the side of the nose
so the meridian ends up in the upper jiao. It goes through the upper
jiao and affects the upper jiao. It’s similar with the Small Intestine.
The Small Intestine meridian is located at the surface over the back.
So when you look at the information in the Small Intestine position
you are looking at the meridian and the Qi level. You are actually
looking more specifically at what’s going on on the surface of the
body.
The Small and Large Intestines:

How can you get information about Small and Large Intestine
organs? Just go a little bit deeper to see the meridian activity as it
relates to the organ. At the very surface is the meridian activity. So
when you look at somebody’s Small Intestine meridian and you

see some choppiness and tightness, that’s probably tightness in the
musculature of the upper back, because that position has to do with
the upper back. You are seeing meridian innervation through that
physical infrastructure. It’s similar with the Large Intestine meridian:
in that distal position you are feeling the surface, the front of the
body, and where the Large Intestine meridian goes. So don’t get
confused by where you are feeling the meridian’s activity versus the
actual location of the organ. You want to see it in the context of the
position because each position tells you something. You can have a
wiry movement at the surface and have something entirely different
going on down below in the same position. All of those sensations
are information for you.
Why am I talking about the Small Intestine (SI) and Large

Intestine in the section about the right proximal position? Because
the proximal position on the right side can be sometimes understood
as SI. That is, you can look at is the right side for SI activity. Why
is that? Because that’s where the SI is physically located in the body.
The Stomach empties out into the SI. When you see a connection,
especially a movement from Stomach going backwards into the
proximal position, it could be a problem of motility in the Stomach,
a problem of movement in the Stomach releasing and going into the
SI. That’s when right proximal can be considered SI. If you don’t
see an overt connection, not at the surface but slightly deeper down
between the two, then it’s not active and they’re working well. But if
the patient has an SI problem or a problem with Stomach emptying,
then you’re going to see a wiryness and tightness in that right
proximal position. So, if the person tells you that she/he has such a
problem, be certain to use this as a learning moment and look for SI
issues on the right side proximal position. If they have an infection,
then you are likely to see Dampness and bulging of the Heat on the
right side.
Remember, you always coordinate these things with the physical

position. Don’t just accept it as a position by itself, because if you see
something there and there’s nothing going on in their SI, then it may
be an upper back problem, a muscle, or jiao problem. The point is

to keep coordinating – just don’t say “I feel this so it must be that.”
Coordinate your pulse reading with their symptoms and their pattern
because it might be something else!
With a model of pulse diagnosis and treatment like this one

you can move from a position of feeling just generalized systemic
information into feeling more localized information. You can look at
a specific organ and how it works. You can separate out each physical
position and those physical positions allow you to look at an organ
and the activity of the organ. Let’s look at an example. Take the
Lung position. The movement should come through the position,
Yang (upward) and Yin (downward) to the end of the position.
This is often not the case. The movement begins to come in to the
position and then ends abruptly. You see the energy start to come
to the position and just fade away or just drop off or discontinue in
some way. One reason that you would feel this is because Lung 1 is
blocked. You can open up Lung1 with needling or massage and then
see the energy start to move through the position. This is a way to
look at a person’s Lung congestion. Another possibility for a Lung
pulse that stops mid-position or sinks as it enters the position is that
the patient has unprocessed or incompletely processed grief. If this
rings a bell with the patient, then you can explain that the position
can be opened using acupuncture. We can force Qi through the
position/organ using acupuncture but they will need to address the
grief.
In the same way, if you want to see problems in the Kidneys,

look at the Kidney position. If you want to look at problems in the
prostate, look at the beginning of the Kidney position on the left
side. The uterus is also there.
Focus your mind on one thing and then look at it in the context
of the jiao, in the context of the whole picture. Separate and feel the
qualities – the physical qualities – feel the rising, feel the horizontal
movement and if they’re not equal, they’re not balanced. There
should be a nice smooth balance through the position; that’s what
normal and balanced feels like.
Right Middle Position, Spleen and Stomach, Pancreas, Earth

Back and forth pulse movement indicates that the person is
worrying. If it is deep, they have been worrying for a long time.
At middle level it means they’ve spent some years worrying and
at the top/superficial level it may have just started. Maybe some
circumstance in their life has begun to cause them to worry. Either
way, we need to get the energy flowing from the Kidneys to the
Heart through the Spleen/Stomach sector rather than being stuck in
there.
Weak pulse can just mean that the digestion is weak. However,
if the weakness is very, very deep it indicates issues about being
nurtured. Perhaps there was some strife in the family when the
patient was younger and he or she didn’t receive, or didn’t perceive
to receive, adequate nurturing. This sort of pulse will undermine
digestion and immune system function. You might feel this pulse
in overweight people because the digestion is slow. If the Spleen
is weak then the patient can’t digest food fast enough and may
eventually become obese and anemic. Tight and weak or thin can be
an indication of hypoglycemia.
Floating in this position can also indicate weak digestion or

Spleen deficiency. Another thing to ask about if you feel the back
and forth movement is digestion and things like bowel movements,
cramping, bloating. Because it is possible that the stomach and
large intestine are not working well together. The energetic pattern
of being stuck in this middle position shows that. In the case of
indigestion, you might also check the left middle (Liver/Gallbladder)
position, because if bile isn’t working properly there will be effects on
the digestion. Both sectors may feel wiry in that case.
Speaking of slow, I often say that I don’t count the beats, but
do know when it’s rapid or too slow and then to pay more attention.
Slow in this position can mean issues with connective tissue (the
Spleen controls connective tissue) or it can mean there is Cold in
the Stomach. In that case (of Cold or Cold congestion) there will
probably be cramping or stomachache, maybe lack of appetite.
Further in relation to Cold, if you just feel like you can’t find a pulse
at all in this position, ask about digestion in terms of food getting
stuck, that is, does the person feel full even after they only eat a small
amount. If so, there might be so much Cold in the Stomach that it’s
not digesting very much. Modern medicine would call this sort of
syndrome gastroparesis.
Although we usually look for scattered in the Kidneys, or at

least that’s where we most dislike to see it, you may also see it in this
position. Again, the digestion will not be working well. It may lack
Damp, fluids thereby, feels unrooted, “dry.” This might also indicate
anemia. When there’s an imbalance in this sector always ask about
immune system function and skin issues.
A hollow or soft pulse here can indicate blood loss, Body Fluids,
or Jing deficiency.
Last, let me say a bit about excess in the Spleen. This might
be felt as slippery or just plain “excessive.” This can be an indicator
of toxic Heat and digestion will be affected. They probably aren’t
producing digestive enzymes very well. The person might have
indigestion, nausea, lack of appetite, and dry mouth or excess thirst.
A note on the pancreas:

As I mentioned above, the pancreas can be found in the Spleen
position. It is on the dividing line of the middle/Blood and organ/
adapted depths, using the 3-depth Nan Jing method. In this system,
it is on what is called the endocrine line between middle and deep.
This is a good place to explain that we have three very basic

levels but let’s add some information. Between the middle and lower
depths is the endocrine range. (Between the upper and middle
levels is the sensory range.) Don’t think of it as five equal levels but
think about it as if there’s a thin line and at that thin line there’s
information about the endocrine system. If you were to superimpose
a line between the upper and middle levels and a line between the
middle and lower levels on top of a sine wave, you will see that the
sensory and endocrine levels are connected. The systems connect,
communicate, interact. In a healthy person they are connected and
working together. Sometimes at this level or a little deeper, if the
pulse is thin it can mean diabetes. Or, talking about the pancreas,
a deep, thin pulse can mean that the pancreas’s function is weak.
Perhaps it is not communicating with the adrenals, leading to some
sort of insulin imbalance. Check the patient’s endocrine function.
Right Distal Position, Lung and Large Intestine, Thyroid,

Metal
Floating here means what we generally feel is true with a floating
pulse, Yin isn’t anchoring Yang. Also, the Lung can be reacting to
Cold or Wind so the patient may have a cough, some sort of sinus
issues, or other symptoms associated with Cold in the Lung. Slow
or thin can also mean that there is an attack of Cold. Aching in the
neck might be related to Cold energy moving upward leading to pain
especially if the pain is strong and sharp. Tight can mean an attack of
Cold and will be accompanied by body aches and chills. Remember,
the Lung is a Yin organ that attracts Yang energy. Without sufficient
Yin, it will not be able to attract Yang, leading to an unhealthy
cycle of losing both Yin and Yang. The Lung pulse may begin to feel
hollow/green onion.
While we’re talking about weakness in the Lung, think
about soft/weak. This means that the Lungs lack Yang and may
also lack Blood support. Not only might the Lungs show some
symptomatology, but, because the pores may be constantly open so
the body is continuously losing heat leading to a Cold condition.
If you feel that you can’t find a Lung pulse at all, that it’s what
some call hidden, that can be due to excessive buildup of phlegm
congestion and they will certainly have other symptoms. In fact, it
may seem incongruent that they have a heavy cough but a hidden
pulse. It’s because the phlegm is blocking any flow to be felt in the
pulses.
Chronic asthma may show up as a sinking and/or thin pulse.

These patients don’t usually show many mucous or phlegm blocks

because their asthma is based on deficiency, or they’ve had it for
so long that the lungs are weaker. Bronchial spasm (asthma attack)
would be wiry in the deep/organ position. Excess pulse would be
Heat related.
A slippery feeling pulse in the Lung position can be some

problem with the Lung not being able to expel mucous or, if the
Spleen is also feeling slippery, it can be a sign of immune problems,
allergies, and/or digestive issues like nausea and vomiting.
There is no pulse for the thyroid, per se. You must look at other
organs in order to see if the thyroid has a problem or not. You can
pick out the physical thyroid pulse usually at the far distal aspect
on the right distal side (end of St and LI meridians). The situation
of the thyroid might be seen in ST9 and LI 18 as well. When you
want to pick up the activity of the thyroid gland you have to look
at the activity in the endocrine part of the Kidney. Combine those
movements with the distal movements. That balance of these pulse
positions is the thyroid pulse. If there is a thyroid problem, the
patient will probably also have problems with the San Jiao and
the Kidney and will show metabolic disorders. Check the water
metabolism and examine their energy level (pancreas and adrenal
functioning) in order to see how much energy is available. All of this
will reflect the activity of the gland.
5 Elements
Think of the Five Elements or Five Phases (5E) in three
dimensions as well as four dimensions. In three dimensions, the 5E
model takes the shape of a regular tetrahedron with Earth in the
center and each of the other elements at an apex. This configuration
illustrates how the Earth’s four branches and each of the other
element’s two branches geometrically combine with the five elements.
The significance of this 3D regular tetrahedron in Chinese

medicine is augmented by an important similarity to its
counterpart in Western biochemistry. In The Touchstone of Life:
Molecular Information, Cell, Communication and the Foundation

of Life,Werner Lowenstein says that life is possible because of this
regular tetrahedron geometry. It makes possible carbon’s ability
to share its four electrons in order to create long organic chains
as well as ionic bonds. Therefore, it is able to store information,
create both symmetrical and asymmetrical bonds, and transmit the
electromagnetic force. If carbon wasn’t able to create this interface
between molecular and atomic levels, the organic chemistry that
creates life wouldn’t be possible.
Similarly, in Chinese medicine, this configuration shows us how

information is stored and transmitted by five elements employing the
Yin/Yang of each element in the stems and their associations with
the meridians in the branches. The 60-year calendar and 8 Pillars
are examples of the way stems and branches can be read. Manaka
and Birch reiterate the idea of five elements as a signaling system in
Chasing the Dragon’s Tail. Schools adhering to the descriptions of
organ/zang fu theory as the sole basis of acupuncture have always
found that the 5E parameters aren’t adequately able to describe the
physiological functions and interactions of the zang fu. However,
when we take the view that these parameters are concerned solely
with the interactive regulation of the zang fu, the channels, and
the related element sets, and are not the physiologic interactions
themselves, then the conflict is resolved.
Following this view of 5E as an information system, the

hierarchy during clinical treatment priorities become: (1) open any
blockage, (2) stop miscommunication of one phase to another, and
(3) treat deficiency and excess.
5 Element Triangles
The familiar pentagram is actually a four-dimensional
tetrahedron, a network of creating (Sheng) and control (ke)
relationships in cyclical time. In this model, problems can be
described in more sophisticated terms. They are no longer considered
to be isolated or necessarily attributable to a single organ or simple
pattern, just a matter of vacuity (xu) or repletion (shi). Diseases can
often be analyzed by disharmonies formed between three organs

configuring a triangle in the five-element network.
In this system, this is considered primarily a problem of

communication and interaction between the organs and, only
secondarily, a matter of vacuity (xu) or repletion (shi). Both types
of features can be found in the pulse. For example, when the blood
sugar drops from physiological stress or from lack of food, the
pancreas releases glucagon to stimulate the Liver to change glycogen
stores to glucose and release it into the blood When blood sugar
rises, the pancreas secretes insulin to transport the glucose from the
blood into the cells; the Liver and skeletal muscles convert excess
glucose to glycogen—Earth, Wood, Fire triangle in both conditions.
When the blood sugar drops and the Liver fails to respond or
has too limited a capacity of glycogen stores, the adrenals attempt
to help compensate for the energy demand. The adrenal stimulates
lipolysis in fat tissue and cortisol promotes protein breakdown.
The stress and the consequential stimulation on the Liver create
nervousness and irritability associated with hypoglycemia. Energy
production in the body is a consequence of and dependent upon
the interaction of these 5E triangles. As in the brain, network
interactions and not individual organs are then the basic units in
5E. In TCM, Qi vacuity is a product of the parts. If one follows
the Sheng cycle of 5E, the movement is from one organ to the next
in a cycle, A to B to C—from the grandmother to mother to son.
Each individual element is, in part, a product of the two preceding
elements, the one creating it and the one controlling it.
I’ve heard people say that you shouldn’t mix TCM with
5-Elements. There is no clear demarcation except, perhaps, in the
intention of the practitioner’s mind during the treatment. Whether
you start with the channels or organs or 5-Elements, the others are
always going to be affected. You can always look at TCM herbal
formulas from the 5E perspective. Such a remark is like saying,
that if we do chemistry, we can’t do physics or biology at the same
time. For example, in this system, we always consider all three (5E,
channel, organ) at the same time because inherent in the Nan Jing
(4th and 18th Difficulties in particular) 5E, channel, and organ
movements are related and integrated. These various styles are not
really so separate and apart. Both try to describe living systems.
Chapter Six
How to take the Pulse, how to read the depths

of the pulse
While it takes time for someone to learn these models and

develop the sensitivity to use them effectively, it can be done with
perseverance—and it will change the way you practice Chinese
medicine. (from A Note on 9‐ and 27‐sectors Pulse Models by
James Ramholz).
Examination of the pulses shows the present energetic balance

or imbalance in the person and has historically been considered the
most accurate of any of the diagnostic procedures. Chances are that
this method of pulse diagnosis (the Pulse Diagnosis and Treatment
System) will be different from what you have been doing. But take
my word for it, learning to examine the pulses in this way will give
you more rewards than you can imagine. The insight that you will
gain and be able to share with your patients will be well worth the
effort of learning and practicing this new skill.
Finger placement
1. You will be using your non-dominant hand for taking the
pulse. If you are right handed you will take the pulse with
your left hand and you’ll be able to draw the pulse picture
and write your notes with your right hand. And vice versa
for those of you who are left handed. It will be the fingers
of your non-dominant hand that you will be placing on
your patients’ wrists. You will use your dominant hand for
drawing the picture of the pulses and taking notes.
2. Use your index, middle, and ring fingers, all at the same
time, right next to and touching each other, using even
pressure. All three fingers exert the same amount of pressure
all the time. Apply pressure with the clear idea that you
are looking for pulsations located at different depths in

each location. Jim never ever let me release a finger or two
while reading the pulses; he believed that way of reading
the pulse was “very wrong.” From the surface, press down
slowly until the place where all the pulse waves are lost on
all three fingers, or the first moment you are clearly touching
the bone. Then, slowly release the pressure until the pulses
are lost at the surface. Press back to about half the depth
between these two (the “ceiling” and the deep) then up and
down to feel all the depths. Theoretically, the middle of
that space between the bottom and top is the demarkation
between the Yin organ pulses and the Yang organ pulses.
Remember, as you go from depth to depth, don’t lose the
identical pressure in all your fingers.
3. Be certain that the whole pillow of your fingertips, rather

than the tips of your fingers is on the patient’s pulse. You get
much more tactile information by using the entire pad of
the fingers rather than feeling with just the fingertips. When
you are reading a pulse position only for relative strengths,
and using the less sensitive tip of the finger, the difference
in sensitivity between the tip and pad is not significant. But
you won’t be able to access the qualities and details of any of
the sophisticated pulse systems using only the tips.
Different depths, sensations, and different theories reveal

different physical, mental, and spiritual functions. For example, the
spread/overlap/spill between jiaos is valuable information about the
interactions and exchanges between organs and parts of the body.
You can also learn to isolate each jiao with your attention so you
don’t have to keep changing hand positions to see things differently.
You only need to change your attention and focus. We not only
read the three depths (Qi, Blood, Organ) in the positions, but can
divide them further into three depths per Qi, Blood, and Organ
for a total of nine depths. For example, the Qi value of the Qi has
to do with the emotions that are associated with that position, and
that are being expressed consciously to the environment. The Qi
value of the Blood depth has to do with subconscious emotions and

the physical symptoms of the emotion that one might experience
without consciously thinking of it. And the Qi value of the organ
depth (what I refer to as the adapted depth) has to do with old or
unconscious emotions.
You always use three fingers and you always use your non-
dominant hand. Why? For one thing, you want to develop sensitivity
in your fingers, your “pulse taking” fingers. I call my left hand
my “diagnostic tool” because it is the only hand that I use to take
pulses. You will develop sensitivity in the fingers that are mainly
used for pulse reading. Playing an instrument builds sensitivity
through more use and activating more parts of the brain. That’s
why we read pulses with only the non-dominant hand—it doubles
the training, sensitivity, and nerve connections in that hand, rather
than dividing attention and time between hands which already have
different levels of sensitivity. Further, sensory information from one
side of the body goes to the other side of the brain. Let’s take right
handed people for example: the right hemisphere of our brains is
about spatial abilities/perception, visual imagery, touch – seeing the
“big picture” -“getting the meaning”. Our non-dominant side of
the brain is about holistic thinking. The right hemisphere has little
ability for language; it is much more about touch. It pays attention
to coherence and meaning and likes to back up everything visually.
Using your left hand for activities, pulse diagnosis in our case, trains
your brain to be sensitive to changes in patterns. It allows you to see
how the patterns work. And the fingers on your left hand will get
more sensitive to energy. Regardless of your handedness, accessing
the non-dominant side of your brain will change your perceptual
abilities and allow you to “see” the pulses more clearly.
Always use even pressure with all three fingers touching each
other, pressing on the patient’s wrist. Why? Because the information
that you want to gain from taking the pulses is not just about feeling
what’s under each fingertip or even under each finger pillow. You will
no longer use individual fingers to feel what’s in this position (under
one finger) and then what’s in the next position (under another
finger) and then what’s there as you press with one finger and lift the
others.
When applying pressure, make sure that all three fingers exert
the same amount of force at all times. The methods of releasing a
finger or two while reading a pulse is very wrong, unless the reader
is looking generally into rather complex chakra or genetic circum-
stance. Apply pressure with the clear idea that you are looking for
two different pulsations located at two different depths of each
location. Physically we can explain this phenomenon by knowing
that the change in pressure will automatically cause a change in
the vibration. The rationalization behind this states that the one
arterial vibration consists of two influences from two different or-
gans. So while it is vibrating in a combined tone, our job is to
distinguish the two component tones. Once we accomplish that,
we can read each tone without the effect of the other. This division
is difficult and demands a high level of sensitivity and concentra-
tion. (From A Brief Survey of the Dong Han System of Korean
Pulse Diagnosis by James Ramholz).
Good health is about the flow of energy that you feel on your
three fingers that indicates the connection between the organ
systems. Good health is a reflection of the communication between,
and synchronization among the organ systems, not about each organ
on its own. Using three fingers touching each other together with
even pressure allows you to see the synchronization in the whole
movement. It makes it obvious whether the movement continues
from organ to organ. Further, using three fingers with even pressure
gives you the ability to feel all sorts of breaks in symmetry, all the
different little movements that are a part of imbalance in peoples’
pulses.
One way to find where to put your fingers is to find the guan
which is in the middle of the styloid process of the radius. That’s
where your middle finger will be and the others just fall next
to it. The cun position is generally in the indentation where we
traditionally find the point Lung 9. Be relaxed, and remember that
location of the pulses is not an exact spot like an acupuncture point.

The pulses are a wave that spreads over a wider area. This area on the
wrists has been called the grand rendezvous of the vessels. So it’s not a
discrete little point, it’s an area.
After you have placed your fingers on the wrist, try not to expect
anything. Have a clear mind. Don’t expect to feel Liver Qi stagnation
or Spleen Qi deficiency or Damp. Just focus and listen. You listen
to what’s going on in the energy that you are feeling flow beneath
your fingers. The patient can be quiet too. In the beginning, as you
are learning this method, you don’t talk to the patient and he or she
doesn’t talk to you. Again, don’t search for anything. The patient has
obviously told you his or her chief complaint. According to your
TCM training you may be thinking “her chief complaint is PMS
so her pulse is probably wiry.” Don’t do that. Just listen to what the
pulse is saying and try to ignore your preconceived notions. Every
pulse tells a story and you can hear it when you listen.
Depth: sensation varies with depth and suggests varying

information. As I said above (but with learning a complicated new
activity repetition is good), go all the way down to where you don’t
feel any movement, then lift up a little until you feel a movement.
That’s the patient’s bottom level. That’s the state of their basic, core
energy. Most of the time the only sensation that you will feel that
deep will be in the Kidney position. Then start releasing slowly
upward until you get to the top where the pulse disappears. Press
down enough to feel something and that’s the top level. You just lift
and press to get all three levels. Frankly there are many more than
three levels, but if you can think about deep, middle, and superficial,
that’s a great start. Realistically, each little increment that you lift
your fingers and release a little pressure is a “level.” Taking pulses
this way may take a number of minutes to do (especially in the
beginning), but it is well worth it.
Since you are applying equal pressure in all three positions, you
will feel/see/hear all the positions (Qi, guan, cun) simultaneously.
Take your time and feel without expectation. This is somewhat like
fishing .... when you fish you wait for the sensation, for the feeling
of a bite, and then you act. Here, you feel a movement and you
write on the patient’s pulse picture. Don’t talk or be preoccupied in
some other way. Start with a blank page, a blank mind despite what
the patient has told you. This is a very important trick - not to try
to match the pulse to what the patient has said. It is called pulse
“reading,” pulse “examination,” and that is what you are doing ---
you are reading a new page about the patient’s health.
Look first for the whole pattern. Then you can analyze the
movements individually and look at the interrelationships. Figure
out what activity is out of balance between the organs. Look for
blocks first, then excesses. Perhaps one organ is the target of perverse
energy from another. See what activity is between the organs. Don’t
just concentrate on the “diseased” organ because the relationship,
the communication (or lack thereof ) between the organs is often the
answer. Looking at all of the organs simultaneously, sometimes gives
you a clearer view than knowing only one or two precise movements
- which, by the way, is all you get when you take the pulses, lifting
each finger as you go and feeling only one position at a time. You
only get to feel one sensation at a time without any information
about how the organs relate to one another. Naturally, sometimes
one organ is responsible for the whole problem but always remember
to check the entire picture and look for connection or flow between
the organ positions.
Take notes, take notes, take notes. Draw a picture of the

movements that you are feeling. Remember, you are taking the pulse
with your non-dominant hand. Therefore, you can be, you should
be, drawing the patient’s pulse picture with your other hand. This
drawing is your record. It is a visual representation of what you are
feeling in the patient’s pulse. This picture is what you will compare
from treatment to treatment to see how the patient is doing. It is
also true that the patient will be interested in seeing it and will ask
you how their “picture” at this treatment compares with their first
picture, the picture that you drew on their very first visit, and how
it is changing over time as the result of treatment. If TCM works,
and if your point prescriptions are correct/accurate, then their pulse

picture should change. The patient’s health should change and that
will be seen by you as a definable difference in the pulses, which may
lead you to draw a different drawing.
The problem when you are beginning to use a model like this
is that you want to look for certain things because the patient has
told you something. Remember, try not to do that. Stop yourself
from doing that. Calm yourself. Become quiet internally and check
the pulse without any preconceptions, without any expectations of
what it should look like. Don’t look for certain things. See what you
feel and believe what you feel. One of Jim’s greatest lessons to me was
to believe what I feel, not to doubt myself. If I think that I’m feeling
something it’s because I am feeling something.
So look around generally or systematically at first, and then look

at the individual organ pictures and the communication between
the systems. You are looking at the pulse as though you are looking
at a film, not a still-shot. You can also look deeper to see if there
is an underlying situation going on. Take a look at the emotional
background (I talk about how to see worry, depression, anger and
their history later in the book.)
That is not to say that if a person has a particular condition,

like cancer, that you shouldn’t feel around for that movement. In
fact, if the patient has any defined condition, like fibroids, then look
for them. It’s an opportunity to feel the knotted pulse. Look in the
left proximal position to see those knots. The patient is your teacher
about how certain conditions feel in the pulses.
Certainly listen to the patient’s chief complaints because you

want to be treating those. After all, that’s why they are coming
for treatment. But you will now have the capability to get more
information about what’s really going on with them from their
pulses. If they have shoulder pain but you see chronic depression
and decide to treat the depression because it’s more interesting,
then they may not come back because their chief complaint was
shoulder pain. They don’t want you to invent new things for them.
Theoretically, and maybe even realistically, could their shoulder pain
go away because you just balanced their entire energetic system?
Of course! But they are expecting to be treated for shoulder pain.
They’re in your office because of shoulder pain. That’s what they
want taken care of so that they can “quit treatment.” Right? Almost
every patient is about quitting treatment, not continuing to get
balanced on a regular basis. So you might want to ask me “if you
feel depression in your shoulder pain patient’s pulse, do you tell him
about it?” I do. I show each patient his or her pulse picture and
explain the whole thing. If I see depression, I tell them about it. I
also explain that, theoretically, treating the cause of their depression
could resolve their shoulder pain because pain is the result of an
imbalance in the flow of Qi.
Obviously some people don’t want to hear that kind of in-depth

knowledge about their life or that sort of insight about their history
when you are examining their pulses. But this method of pulse
diagnosis gives you the ability to have that insight and I suggest that
you use it. You will get the general overall view of what’s going on
with them and you will also see all the other factors that underly
it, the emotional issues, and all the physiological problems. All the
causes. Yes, patterns from old unresolved emotional issues can be
the cause of your current pain, or digestive issues, or your headaches.
Isn’t this, finding the cause, finding the root, why we are practicing
TCM?
On the other hand, there are those patients who are ready
to hear that sort of information. When I am going over the pulse
picture and explaining what it means, most of my patients appreciate
the insight. That is partly why they are coming to see me instead of
another practitioner. They are amazed that their energetic system
“shows” me their depression, their worry, their early childhood
issues around nurturing, etc. We talk about what it means for their
general health. I feel that it is my responsibility to explain what is
going on in their energy, show them how their emotions are affecting
their health, how worry messes up their digestion, how anxiety is
disturbing their Shen and their sleep, how not feeling adequately
loved as a child has made their digestion not work well for their
entire life, etc. I show them how this all looks. And when people
hear it, they can’t deny it, and so they say “yes, that’s true about me
or my life” and wonder how we move on from here with treatment.
They understand that those old imbalances are the cause of their
symptoms/condition and they would like to move toward a healthier,
happier life. That’s the treatment plan.
As you can probably tell, one of the most important things for
me as a practitioner (and all of us) is to figure out why the symptom
is happening. A lot of people have the same “stuff.” They’re Spleen
deficient; they’re Liver stressed. But you want to see specifically why
those things are happening in this case. Believe it or not, not all PMS
is caused by Liver Qi stagnation. There may be a lot of similarities
between people over time but you want to be able to have a clear
picture of each person and be certain that nothing extra is going on.
Additionally, in their pulses, you will see problems that they don’t
know about, problems that are building but have not manifested
physical symptoms yet.
Some of the classics say to take the pulse only early in the
morning so you don’t have all the busyness of the day, all the
emotional stuff of the day, all the stress of the day interfering with
the pulse. Well, no matter what time of day you take it, the pulse will
show you those things .... where the person lives .... all the fixed little
energetic things that are stuck in their system .... all the constant
patterns that break the symmetry of a healthy, balanced pulse.
Finally, practice, practice, practice. This is a tactical skill. It is

a very focused activity; your attention is focused. Your mind has to
be clear. Sense and listen to what the patient’s body is telling you.
This new skill will take a bit of practice to perfect, but you’re lucky
because you take pulses every day. Having a list of qualities (the old
way of taking pulses) is more simplified than looking at a number
of windows in space (the space under your fingers). BUT, you get
so much more information using this model that the practice is
worth it! Your patients will be amazed with your diagnostic skills.
They will think that you’ve “read my diary.” The physical part of
taking the pulse now becomes the focus and may seem more difficult
because there’s so much information available to you. At first, you
might feel sensory overload. But you will get good at organizing the
information, figuring stuff out, and seeing patterns that will become
consistent or that are present in a lot of people. Your perception of
the sensations that you are feeling will get reinforced.
Just as an interesting historical note, here is what the Mai Jing

says about pressure and depth. It was an attempt to help students
figure out how much pressure you need to reach a specific pulse/
organ depth.
Application of Light & Heavy Pressure in Feeling the Pulse:

Examination of the pulse demands the application of light or heavy
pressure. What does this imply? The answer is as follows: pressure
equal to the weight of three soybeans penetrates the skin and hair
and reflects the Lungs. A pressure amounting to the weight of six
soybeans reaches the blood vessels and reflects the Heart. A pressure
amounting to the weight of nine soybeans reaches the muscles and
flesh and reflects the Spleen. A pressure amounting to the weight of
twelve soybeans reaches the level of the sinews and reflects the Liver.
Finally, press to the bone and then release the pressure. If then the
pulse comes impetuously, this indicates the Kidneys. This is what is
meant by light and heavy pressure.
Lung/skin, hair, meridians/3 beans
Heart/blood vessels, peripheral nerves, superficial muscles, 6

beans
Spleen/flesh, lymph, connective tissue, 9 beans
Liver/sinews, deep muscles, 12 beans
Kidney/bone, 15 bean
Chapter Seven
Emotions associated with the organs and their

energetic signatures
Since emotions often cause or underlie many somatic problems,

I try to spend a lot of time in my seminars showing how they are
involved. Some of these patterns go back to early childhood. When
a patient has strong emotions that are negatively affecting the flow
of Qi in their body one way to go about treatment is to buffer the
situation and build up their vitality so there isn’t such a strong
imbalance. We can support their physiology to change/deal with
the imbalances caused by their emotional stress. Then they can start
working on the other aspect, the psychological stuff, because even if
you balance everything it might continue to be unstable - they may
need to do some work. With acupuncture you can build up their lost
vitality and balance as you go.You have to give their body a chance to
marshal its resources.
Symptoms often involve emotional issues going on and

sometimes the pathomechanism goes far back in the patient’s history.
I treat people who have suffered what is called the relinquishment
wound or early childhood loss, early childhood separation, some loss
of nurturing. This is evident in a person’s pulse because the Spleen/
Stomach sector is sunken, it feels deeply empty, it might even feel
as though your finger can feel a pulling down or sucking sensation.
With the nurturing underpinning missing, a person’s emotional
life can be insecure and scattered. People often think that they
have resolved an issue but much of its effect still lays hidden, but
influential in their body.
Somatasization of an emotion may occur and can affect an

organ eventually. For example, long term fear may make the patient
lose control over his/her bowels or bladder. And we often find that
worry or neediness that started in childhood affects the Spleen/
Stomach/digestion as an adult. But, an emotion doesn’t necessarily

have to create symptoms commonly associated with the organ either,
although it can if the emotion is long-term or very intense. The
emotion and the organ are connected through their association with
one of the 5 Phases. Because the texts are interested in analyzing
and treating some pathology, the examples presume a long-term
or intense emotion. They are not interested in transitional action
or situations where the patient rebalances and recovers himself.
The Chinese idea of an emotion relating to a single organ is a
simplified picture. To understand any one emotion you have to see
it in 5 Element context. Desire is not one thing, one emotion; it
is a mixture of emotions. So you need to see how it relates to each
organ. For example, there will be several different manifestations in
the Spleen pulse and its connection to other positions, depending
on whether the desire involves an exciting occasion, such as the
excitement of a new relationship or an approaching wedding.
The general pulses related to desire will be modified again by how
reserved, repressed, or guarded the person is about their feelings in
general.
When a patient’s suffering begins with or is rooted in emotional

issues around lack of nurturing, it becomes your job not to
psychoanalyze them but to at least draw their attention to the root,
and direct them to help if they need it. For example, think about
this case: the patient has suffered from insomnia for the last 14 years.
Pharmaceuticals and supplements sometimes helped but they would
finally be ineffective after a while, at any dose. From examining
his pulses, it was apparent that 14 or so years ago he had some
trauma which turned out to be a very bad breakup of a personal
relationship, his father died, and he had to move his aging mother.
All of this combined to create the emotional/physical trauma that
was at root of his problem. It was clear that those emotional states
caused the Kidney weakness, Liver stagnation, and blockage from
Liver to Heart. And, because that emotional trauma had never been
fully resolved and was still evident in the pulses, he did not recover
organically either. From modern medicine’s point of view, there
are no separate networks in the brain and nervous system nor any
separate neurotransmitters for emotions. But psyche and soma are

two sides of the same coin both in CM and MM. The bottom line
is that people’s lives can be transformed using Chinese medicine and
treatments guided by this diagnostic system.
This next section is just a short review about emotions since I’ve
told you that you will have additional insight now and be able to
read the history and current situation of your patients’ emotions.
Think about the emotions associated with each element or organ

system along with its physical position of the pulse.-
Wood
Balanced = assertive, rooted, flexible, growing,
decisive, controlled
Out-of-balance = angry, uprooted, rigid, disconnected,
stiff, intolerant, inflexible, aggressive, hateful
Fire
Balanced = joyful, vital, warm, dynamic, nourishing,
moving
Out-of-balance = is over-emotional, hyperactivity,
fanaticism
Earth
Balanced = empathetic, grounded, stable, serene,
meditative, centered
Out-of-balance = worried, ungrounded, empty,
unstable, nervous, bulimic, anorexic, anxious, sexually
deficient or excessive
Metal
Balanced = compassionate, strong, structured,
communicative, empathetic, reinforcing
Out-of-balance = depressed, has chronic grief,
dependent or co-dependent, non-supportive,
overprotective
Water
Balanced = careful, fluid, confident, serene, courageous
Out-of-balance = fearful, fickle, genetically
disadvantaged, out-of-balance
Our ability to see these imbalances in emotional states/elements

in our patients’ pulses allows us to help our patients rediscover
their Essence – maybe even facilitate the development of their
consciousness and insight – help them restructure their “rules”.
Energetic Signatures of Emotions
Depression
Depression feels like a cosine movement in the Liver position.
It is a reverse movement in the Liver position. The movement is
cosine rather than a sine wave or bell curve. Instead of the movement
coming in from the Kidneys as a rising Yang movement, the
movement is sunken and moves upward. (Check back to how the
cosine looks). The movement feels like a trough at the beginning of
the Liver position rather than a rising motion. Or it might feel soft
or feels like there’s a hole there, a sinking at the beginning of the
position. Five elementally, the Wood element is reversing.
You can look at depression in three levels/depths. We know

that the top level is the Qi and emotion level; the middle level is
metabolism, blood, function level; and the lower/deepest depth is
the adapted emotional pattern, organ depth. If the cosine movement
is at the top level (Qi), the person is depressed; they know they’re
depressed. That may even be why they contacted you for treatment.
If the movement starts more from the middle depth it means that
their depression exists but they may not be consciously aware of it.
They are not immediately aware of the emotionality but have all the
physical symptoms of depression - lethargy, low libido, excessive
sleep, no motivation, don’t want to eat or eat too much, etc. The
movement shows the reverse of what should be growth in their life.
Wood element is about growth and development. So if the Wood
element is reversing, then the person is sort of in a state of stasis

or depression. They’re not growing; they can’t grow; they are not
expanding themselves. If the movement is at the bottom/deepest,
level you know that it’s a sort of adapted, very old depression that
they think they might be over or never even recognized. Or it’s a
depression to which they have adapted, and that is the personality
that they express to the outside environment. It’s an old emotion that
hasn’t been fully resolved. They may think that life is tough and then
you die. That’s not a very joyful way to look at life.
Remember, what you feel at the top/Qi level is what people

express to the outside, but what you feel at the deep level is
what they feel on the inside, their adapted energy/personality.
By examining their pulses and feeling the deeper movements for
depression, you will know that what they present on the outside is
not who they truly are, or what they are feeling on the inside. And if
they tell you that they don’t feel that way (depressed), that’s denial.
It’s denial because you can feel it; you know that it’s going on in an
adapted sort of way. Remember, when your skills are sufficient and
you see something like this going on but the patient denies it, they
are not being honest with you. They’re not being honest for a variety
of reasons - they don’t want to believe it; they are in denial about
it; or it is very possible that they don’t feel it. They have adapted to
it so well that they don’t even “feel” it or they think it’s just normal
for people to feel that way. It is where they think they should be,
how they think that their life should be, but most people don’t think
their life should be “depressed.” Depression is still a word that carries
a negative connotation. But you will know that depression – the
energy of depression - is a constant undercurrent in some people’s
lives.
If your patient is taking antidepressants, it’s worth diving
into. Their antidepressant may give them relief, which is good, but
the underlying, original cause is still there. And, the patch on the
symptoms gives you a window of time in which to work to help the
person get off the prescription and on to a treatment plan that you
recommend. Don’t forget, the antidepressant drug doesn’t support
the pancreas/Spleen and won’t take care of their Liver stress. It
won’t deal with the adrenal aspect. You can see in the pulses that
those organs aren’t helped by the drug. In the Liver position it’s
supposed to be a nice sine wave, right? But in people who are on
anti-depressants, it comes up and gets clipped off or hits a ceiling
rather than moving into the Heart position. It’s a blockage that is
very characteristic of antidepressant therapy. The drug is interfering
with the relationship between the Heart/spirit and the other organs,
especially in the sensory level. It’s not letting the Heart feel and will
eventually damage Liver Yin and Blood.
So it’s not that the person isn’t depressed anymore; you can see
the cause of it in the pulses still. But the drug interferes and stops
the sensory acknowledgment of that depression. It helps the central
nervous system relax in a way, but the cause, the wound is still there
in the energetic system and the brain even though the patient feels
a sense of “normalcy.” When someone says that they want to get
off their antidepressant they need to realize that the drug isn’t the
problem. The drug gives the person (and us) time to work on the
original issue. If the person doesn’t have the strength to deal with
his/her emotional wound, then we can support movement toward
that by tonifying their system, building their resources, their vital
energy. It will make them worse over time if they don’t deal with it.
The drug therapy will stagnate the Liver and Heart and since it’s all
about flow - the Kidneys will eventually suffer as well. The drug is
doing something very specific: managing serotonin, but all of the
other systems are still in jeopardy. The deep movement we can feel in
depression is the most difficult to deal with because the patient needs
to also do work.
Anger
Anger feels like excessiveness of the Liver shooting up toward
the Heart position.
The Heart is closed; the person is joyless. In order to have joy

you have to have Heart fire opening and spreading. It’s not that
the person is depressed. They can be perfectly “normal;” they can
be doing all of their business, going through their life each day,
but their affect is flat. There is no joy in their life and they may not
even realize it. They say “I don’t have real highs but I don’t have real
lows either.” That is because their Heart is closed. If you don’t see
movement through the Heart position it is probable that the person
is leading a fairly joyless existence. If a person has been abused,
especially women, you can see the pulse movement come into the
Heart position and then it gets cut off. Sometimes it comes up
from the Liver and it’s like water being sprayed against a wall – it
shoots out in all different directions. That is the movement of a very
disorganized, disturbed Shen. The Heart cannot accept the stress
from the abuse and tries to dissipate the out-of-balance movement.
Sometimes the diaphragm acts as a barrier for perverse energy that
is headed toward the Heart. The Heart will not acknowledge the
movement/energy, because all the unconscious, buried stress from
the Liver is moving toward it. It has protected itself sometimes by
going as far as blocking the diaphragm (Dai Mai block). When it
does that the first time it’s a protection so the person can get through
the abuse. But if it stays like that, it becomes a problem because even
though the initial trauma is gone and even if they’ve been in therapy
etc., if that blockage is still there, they’re still guarded …. still very
much protected and still very joyless.
Sometimes in the Heart position you will see a movement like

a rock in a stream. The movement comes in and then it spreads
around, sort of splits up, over and around or over and under, but it’s
like water flowing around a rock in a stream. That sort of movement
is a little better than the “spray” type movement, but the Heart is
still basically closed. The Shen is still protecting itself. There is still
an isolation of the Heart or Shen. There is a connection between
Heart and Liver albeit it’s an imbalanced connection. Whether or
not the patient wants the connection to be opened or whether or not
they can stand for it to be opened is a separate issue. I don’t want to
confuse this sort of emotional stress with acupuncture points being
closed. If you work on someone, needle or massage points and you
still see movements like the ones just described – then it’s definitely
Shen disturbance. People may not admit to abuse and may not tell
you, but the results of it are a fixed feature in their pulse picture. The
unconscious stuff may start to come out in dreams where it’s safer,
and there’s certainly stuff that they know intellectually, but they’ve
isolated and separated emotionally. That separation, that isolation,
is a protection that ultimately needs to be resolved for Qi and Blood
to flow through all of the organs (= good health). This is the sort of
thing that you will see in people who have been traumatized.
Remember, in the normal sine wave movement everything

connects, everything is transitioned, everything is transformed
so that only the normal, balanced pattern is maintained. But
with depressed patients, what you are going to feel are little fixed
movements going on in the pulse that break the sine wave down
– destroy the symmetry, destroy the balance –and show the lack
of communication between the organ systems. Without treatment
these out-of-balance movements will persist within the patient and
continue to cause physical and emotional symptoms.
Worry
Everyone worries. … at least sometimes. What do you know
about worry? You know that it’s not good for you. Why not? Because
it weakens the Spleen and damages digestion. In addition to worry,
people sometimes eat poorly in terms of choosing nutrition over
convenience; they overwork, and over think. Let’s look at what
happens when you think about something. Previously I said that the
San Jiao is the brain and is felt in the right Qi/proximal position. It
represents the frontal part of the brain. When you are thinking about
a problem, thinking about it over and over, all that extra activity
comes out of San Jiao (Kidney position) and moves toward the
Spleen. In a healthy energetic system, the Spleen (Earth) should be
able to take that energy, accept it, transform it, and send it on to the
Lungs. It would be able to keep the flow going and support the next
organ in line. That’s what a normal, balanced pulse movement would
do. But if the Spleen is weak you will feel a movement that comes
out of San Jiao (Kidney position), but the Spleen can’t accept it, so it
throws that stress back toward the San Jiao/Kidney position. To you,
it feels like a movement coming into the Spleen position, which then
turns back toward the Kidney position, back and forth, back and
forth, back and forth. The Spleen throws it back and usually throws
it back deeper, more toward the Kidneys. That makes the reverse
movement even more damaging to our Kidney energy.
In the Shen cycle, energy moves from Shaoyang/Fire to Earth

to Metal; that’s the normal movement. But when worry happens,
this generating/Shen cycle isn’t being supported or accepted by the
Spleen. Spleen is too weak to take on perverse energy and just throws
it back toward the Kidneys. It would be similar to a situation like
this: you just finished working all night, you’re on a deadline, you’re
exhausted and irritable and someone comes by and says “Good
morning!” You jump up and say “don’t talk to me! I’ve got to get this
done!” You are so tired from working all night that you can’t even
accept the normal social greeting that everybody says and that shows
healthy interaction between people. You just go off at the person
because you can’t take it. You can’t take any more stimulation, so
you throw it back at them. You are throwing your own anger and
frustration back at the person who said the greeting. With chronic
worry, the Spleen is having that sort of reaction. The Spleen gets too
weak (tired) to handle energy coming from the Kidney Yang/San Jiao
position, so throws it back.
When an organ is strong enough, when it’s healthy, it transforms

any energy coming toward it and passes it on to the next organ. But
when the organ system is weak, it’s going to start throwing energy
back or, obviously, may develop a problem itself. This negative cycle
is dangerous because when the Spleen throws energy back, that
imbalanced energy becomes buried deeper in the Kidneys/San Jiao.
Let’s take a look at the “worry movement” at different levels.

At the Qi level, it’s emotional energy that doesn’t transform and is
thrown back. This is current worry; the patient knows that he/she is
worried. The energy still gets thrown back to the Qi/Kidney position
and has the potential to change the physical structure. You will see
the movement in the Qi level come toward the Spleen position and
then go back deeper. This is a good example of Five elements at the
emotional level changing Five elements at the physical level. You

are seeing an emotional response change a physiological structure
as time goes on. If it happens just a little bit, it’s no big deal. The
Spleen recovers and it can transform energy again. The body repairs
itself. But this movement becomes a big deal when it is a relatively
fixed feature in the pulse. When it’s a fixed movement (i.e. you feel
it every time) it means that the Spleen may recover a little bit, but it
doesn’t stay recovered. Emotional stress (worry), poor diet, overwork
etc. has just made the Spleen too weak to deal with even the basic
generating cycle. And if that weakness is there for a long period, you
have a person who worries almost continuously. The person worries
to worry. It has become a habit. He/she can’t not worry because
the Spleen isn’t strong enough to create a balanced movement. The
person has switched from a time when he/she could worry and get
over it, to having to worry. The worry weakens the Spleen and the
person stays worried because the functional aspect of the Spleen has
been weakened.
So we know that feeling the movement at the surface/top level is

a conscious worry. The person has something on his or her mind, you
can see it in their face and ask them about it and they can talk about
it because it’s at the conscious level. When you feel it in the middle
level, it means that what the person shows to the outside world is
one thing, but subconsciously they are worrying. They can keep up
the conversation, they can interact with you, they can have lunch
with you, but there’s something going on underneath. Their mind
always turns to this worry. Now it has become subconscious. In their
pulses, you may see the movement vacillate between the upper and
middle levels, but now it’s becoming a more permanent fixture in the
middle depth. Finally, when you feel the movement in the deep level,
it means that San Jiao/Kidneys are sending energy to Spleen and
Spleen is throwing it back. It looks like a tight parabola or sometimes
straight back at the deep level – this is worry at the adapted (deep)
level. These are people who were “born to worry.” Obviously a child
isn’t “born to worry” but this person’s worrying process started early.
You feel it at the adapted level so it is a very old process. Very often,
this movement is seen in people who come from families where there
was alcohol or other drug abuse, or where the parents had to care
for a sick child, or some other ongoing family imbalance. It can be
the pulse of the co-dependent person. Remember, when you see this
sort of deep process/movement, the person is not even aware of it
anymore. It’s just the way their world is. Worrying is an old habit
that just won’t stop. They don’t even react to it anymore. When
you ask “do you worry at all?” they will probably say “no.” When
the movement is still in the middle depth, they can react to it with
different thoughts. When it’s at the surface level, they can become
aware of it. But at the deep level, the worry is rather adapted and
it’s just part of their system. Their life is a worried, dangerous place
where they always have to be a little bit nervous; they always have to
be careful.
When you feel the worry pulse at the deep level, also check the
left side proximal position because you want to be able to see how
much fear there is, how much insecurity all this worry is creating.
The worry has weakened the Spleen through a vicious cycle, so you
want to see what’s happening to Kidney energy. Worry may turn to
or create fear. If the Spleen becomes too weak it starts to pull Kidney
energy into the imbalance and you will start to see the Kidney energy
get weaker and even scattered. The Kidney pulse may feel like a little
shaky, nervous movement in the Qi position. If it’s just a little shaky/
choppy, it’s insecurity. If it’s a cosine or a real severe strong shakiness,
then it’s more fear. I describe scattered as what the top of fireworks
look like in the sky ….. they’re just small pieces of light floating in
the air. They flicker at different times. You feel little flickers of energy
on your finger. A deep cosine would mean internalized fear that is
very controlled for the outside observer. Otherwise you would see the
person cowering and crying in a corner. That shakiness is insecurity
that undermines everything, all the time.
Finally, worry is always subverting Spleen function. Even if

the person doesn’t have a digestive problem now, they will in the
future. They may have something else at this point – they may be
susceptible to infection, their immune system may be very weak,
they may get all sorts of recurrent problems, allergies, sensitivities,
or skin problems. That is because worry has compromised their

Spleen energy. Having a continuous drain on Spleen energy does
not create a happy life. And remember, sometimes lack of emotional
nurturing during childhood, or the perception of lack of nurturing,
undermines Spleen energy and digestion. This person’s digestion has
probably never worked very well and they probably have some of the
other issues mentioned above (skin issues, allergies, etc.)
Grief
I learned from talking about grief with Jim that it isn’t
necessarily a Lung sign. It can be caused by multiple patterns
that are not just from the Lung and Heart. Grief is related to the
Lung through its association with the Metal phase similarly as the
Large Intestine is related to the Lung. Part of the problem comes
from a relatively simplified view of emotions held by the Chinese.
We know from modern medicine that emotions operate as a
complex system in the sense that they emerge from interactions
of constituent neurohormonal, motor, and experiential processes.
Individual emotions can also co-assemble with other emotions to
form contingent patterns that stabilize over repetitions and time.
While we can see emotions like grief related to a particular pulse
position (right distal, Metal), they do not necessarily directly affect
an organ. They manifest at a different depth than the organ although
prolonged or repetitious emotional states can, in time, change the
organ’s functioning. It is an oversimplification to say that an emotion
relates to one organ only. Think of grief similarly to the way a Large
Intestine problem may affect the Lung. If one is excessive in terms
of time or intensity (too much grief ), the other can become depleted
(in this example, Lung).
Grief often feels like a block or drop in the Lung position. The
Lung Qi does not flow through the position; it’s stuck. This can be
old, unresolved grief.
This pulse diagnosis and treatment model becomes even more

important because emotion plays such a central role in our lives.
Even Western neurobiology has come to that. All of our emotional
stimulation goes to the brain stem and it’s there that the brain says
whether or not this stimulus is important enough to pay attention to.
If not, your body just keeps going. For example, I can stand in front
of class and keep my balance and I don’t have to think about it. It’s
not an issue or even an idea in my mind. My being able to stand up
in a balanced way automatically happens. Then the information goes
to the amygdala and it’s here that the emotional value is placed on
it. The connections are made within different parts of the brain. It
then goes to prefrontal lobe and that’s where the conscious awareness
of it goes on. The terrible twos: children have lots of neurons but
not a lot of synapses. It’s the mother/primary caregiver’s role, with
the infant before he/she is able to speak, that helps modulate all the
physiological processes that go on in the brain, and help the child
modulate his/her own emotions. The reason why the terrible twos
are so terrible is that there aren’t a lot of connections between the
amygdala, where all these emotions are coming up, and the frontal
lobe, which helps control and modulate them. So the child has
tantrums because he/she just doesn’t know what to do with him/
herself with all that emotional sensation. So the primary caregiver’s
role in changing the behavior actually changes physiological
structural connections in the brain. Relevance to you? We can start
to see in the pulses those sorts of connections - emotional stuff
that’s going on that affects the physiology and ultimately affects the
structure of the body - and we can change that with acupuncture
when we can properly see it in the pulses.
Chapter Eight
Point combinations and treatments
I am not a fan of what I call “prescription” Chinese medicine

which is using the same selection of points over and over again each
time you see the patient. In fact in an online group recently someone
asked why people feel so good after the first treatment but then when
you do the same exact points on the second treatment the effects
aren’t as strong. Well, for one thing, if your first treatment worked
then the person will be somewhat different on the second treatment.
So why would you treat them the same exact way? Because that’s all
you know; you only know the acupuncture point prescriptions in
books. That being said, I want to offer you some point combinations
that will help you get started using this pulse diagnosis and treatment
system. I would like you to have some combinations to fall back
on if you take a pulse and just don’t know where to start with your
point selection. Remember, the goal of your treatment is to take
the imbalances out of the patient’s pulses and make their pulse
normal (balanced sine waves). Having that goal may lead you to
use acupuncture points that you haven’t used in a long time. This is
good! We learned all of those points for a reason. Using this system
of diagnosis will allow you to be creative in your point selection and
help you learn new aspects of point functions. That call for creativity
is what keeps me very excited each day that I practice Chinese
medicine.
Depression:
To treat depression with Heat, Heart Fire, Heartbreak, and/or a
Heart chakra that is shut down, open the Heart and use the Stomach
channel to take the Heat and Fire down.
Open the Dai Mai.
St 25 consolidates and moves things down through the colon
St 32 moves Heat out
St 41 Fire point
This treatment opens Heat in the Heart and moves it down
through the Yangming channel. It is sedating the Child to modulate

the Mother. NOTE: This treatment will not work well if there is
blockage at the diaphragm or Heart deficiency. So if the patient’s Dai
Mai is blocked, you need to open that before you do this treatment
prescription.
For lighter depression: needle K 6, 16, and 27 (on K 27 point

the needles outward/lateral, toward the lateral part of the shoulder).
This choice of acupuncture points uses Shaoyin to open the energy to
the surface and bring it out. Therefore, it may lead to crying (or not).
It sends Kidney energy up through the Heart, opens it, and vents it.
Old emotional energy that’s stuck needs to be released and this is one
way to do that.
Depression with lots of Liver stress: in this case the Heart and
central nervous system can no longer accept stress so it’s forced
somewhere else. The Heart will protect itself at all costs. In the
pulses, this will generally feel like a block in the pulse movement
at the Heart position. Besides depression, this person may have
angina, tension, and/or pain in the rib cage. Needle Gb 34, Du 20
(to protect the brain), H 8, Gb 21 and then H 7. This treatment
discharges physical and emotional tension. NOTE: Needling H 8
sedates the fire of fire making the Heart draw on the Liver to reduce
its stress.
To open the chest for deep grief, for Heart chakra problems,
this treatment expands the energy out. A closed Heart feels like a
drop in the Heart position or a stone in a creek in that position.
This combination will also work on the emotional aspect of thyroid
problems. Use the K 6, 16, and 27 combination along with Ren 17
and Lu 1 to help recycle Kidney energy. You are using Yin meridians
to fill the Chong Mai.
Depression: Is it Liver Qi depression, stagnation, or constraint?

How is “binding or Liver depression” any more precise than
“stagnation” or “constraint”? To have those physical symptoms
doesn’t necessarily mean the patient has emotional depression and
vice-versa. If we judge through symptom pattern, then I don’t see

why one isn’t as good as another as long as we are consistent. But
if we are looking at the pulses, then these can be three different
presentations for someone who does more than the basic Chinese
medicine pulse diagnosis. Depression related to the emotional aspect
is consistent with the way we see and discuss Liver problems in the
pulses. Depression is used when a Liver pulse shows that emotional
expression at the Qi depth (using the Nan Jing 3-depths method and
its variations). Stagnation clearly expresses a more physical issue.
Asthma:
Sometimes, when the asthma is long term, you might feel a
tightness in the chest area that is the result of long-standing muscle
tension. Some asthmatics have tightness in the back where the
diaphragm attaches that also contributes to shortness of breath.
The flu
Generally speaking the flu pulse is Heat filled especially in the
Lung and Spleen but Heat in the Kidney pulse is a sign of flu rather
than just a cold. And, the patient will have accompanying symptoms
like body aches.
Think of these points for both asthma and flu: Lu 1 (dissolves

mucous), 5 (can make the Heat flow in another direction;
strengthens the lungs), and 6 (moves Heat out); Liv 2 and 3 can
help reduce body aches if the Liver is shooting energy out to the
muscles. Use St 36 to pull Heat down to the lower jiao. Du 20 can
also prevent the Heat from rising. The combination of Liv 14 plus
Lu 1 soothes the Liver and the open lungs. I like to support Water to
remove Heat - Bl 39, 40 and Kidney 7. Use LI 4 to reduce Heat in
the upper jiao, Ren 22 for cough, DU 14 for wheezing, and one can
do the Huatuojiaji points to reduce symptoms.
Thyroid problems: Sp 3, St 40, Lu 1, R 17, Liv 3, moxa K7.
Anxiety: I call this prescription Decompress the CNS. This

treatment is an absolute must for patients whose pulses are shaky,
who are anxious, who can’t sleep, etc. Needle Gb 34, Du 20, H 8
to calm the brain and Heart. Then H7, Sp 8, Ren 12 and St 36 to
fortify the system. A gentle needling works well; there’s no need to
do any thrusting of the needles. You don’t have to beat up the Qi
.... a gentle stimulation can make a dramatic change in the pulse
movements.
Deep, chronic weakness in the pulses: The Core Energy Boost

treatment is a perfect prescription for people suffering from
fibromyalgia and chronic fatigue or anyone who is really run down.
Needle Ren12 then needle SJ 4 pointed inward toward the body
- so toward the patient’s thumbs, needle Sp 6, 9, & 10 pointed
upward (toward the patient’s head), Gb 34, K 10, St 36 and Bl 39
also pointed upward. Pointing the needles upward guides the Qi to
the Mingmen and middle jiao where the energy is needed. Other
combinations you can use include combining Lu 1 with Lu 5 to
help energy go to Kidneys. Needling Lu 1 pointing it toward Ren
12 can connect Spleen with Lung. In this treatment, everything
moves to Chong, to Earth, and spreads out. Energy from the surface
meridians goes to the core to help rebuild Qi.
Some miscellaneous treatments:

LI 11 and Lu 5 connect Water and Metal.
To stabilize the endocrine system: Treat Kidney and Spleen.
Moxa on K1 pushes the Qi through the channels the way

our body did when we were younger. It builds up the GI tract to
improve the quality of post-Heaven Qi.
Use K1, Ren 17, and Lu 5 to bring excess Heat down to the
Dantian to tonify the Kidneys.
Feeling strong upper level pulses in the elderly: pulses where it

feels like the Yang is rising up to your fingers strongly because it’s
unrooted, does not mean that they have strong, good, healthy Qi.
It means that their body is working harder to maintain itself. Their
organs (deep pulses) are empty, deficient. Their solid (Yin) organs
aren’t storing energy anymore. Energy is shifting upward to the
nervous system level without replacing the deep energy. So don’t
think that a strong pulse in the elderly is good. Examine where the
strength lies. If it’s all on top, that is an unhealthy sign.
Treating Parkinson’s disease: the typical Chinese medicine way

of treating Parkinson’s disease is to sedate Liv 3 and G 30 to sedate
Liver Wind and then to tonify the Kidneys. But Parkinson’s disease
is a neurological problem so shouldn’t we be treating the brain/CNS?
You should see a choppiness in the San Jiao (right Qi) position.
That is equivalent to the brain. This is where you need to focus the
treatment - at the cause of the condition, not by only treating the
symptoms. Treating symptoms is not Chinese medicine. We may
help reduce symptoms but the important thing is to treat the cause,
the root by balancing the organ systems. Trying to reduce a patient’s
tremors by reducing Liver Wind is wrong headed; it is treating
the symptom not the cause. That’s not how Chinese medicine is
supposed to work. Treat Kidney, San Jiao, Du Mai, and Gallbladder
points to treat the CNS.
Treating Autoimmune conditions

The condition involves Wei Qi. Even though there may be a
general depletion, you might also see perverse Heat in the pulse
movement of the Lung (Metal) attacking the respective tissue of
the specific autoimmune disorder. The issue can’t be translated into
academic TCM terms, but it can be efficiently translated into 5 Phase
terms because immune function and 5 Phases are both dynamic and
describe living systems. In these types of complicated conditions,
we need to examine 5 Phases within each Phase - so Metal phase
for autoimmune problems. There is a correlation of the immune
system in modern medicine terms to the combined organization
and functioning of the Spleen and Lung (or Earth and Metal) = the
immune system in Chinese medicine. Treatment for autoimmune
problems is difficult because you have to do two things at the
same time: stop the attack on a body tissue while supporting the
deficiencies of the immune system.
PMS:
If blood stasis is the primary problem the pulse will be tight and
choppy. A wiry movement in this condition, especially if it goes from
the Liver at a sunken depth back to the reproductive organs in the left
proximal, usually means uterine muscle spasm often accompanied by
Yin and Blood insufficiency. This is the definition of cramps - uterine
spasms caused by lack of oxygen. It belongs to Shaoyang type of Yang
energy; usually in the sinews, tendons, or connective tissues. If this
pulse combines with any type of Heat it can indicate inflammation
of the connective tissues.
Symptoms like painful menses, skin rashes, facial acne, bleeding

with heavy clots, dark red-purple menses, and insomnia sound like
Liver stress going back to the reproductive organs [counterflow].
This is not unusual in many cases. When Chai hu is added in large
amounts or large proportions to the other herbs, this formula can
strongly course the Liver and cause these kinds of side effects by
releasing it too quickly.
This is a copy of Jim’s PMS formula, based on a Hua T’o

prescription:
Tao ren 20
Fu xiang 16
Dang gui Wei 12
Yan hu suo 10
Chuan xiang 10
Mu dan pi 10
Zhi ke 10
Cang zhu 10
Chi shao 10
Huang Qin 8
Huang lian 8
Sheng di huang 5
Hong hua 5
Wu ling zhi 3
Pu huang 3
San Qi 3
Xio hui xiang 3
Mu xiang 3
In the right combination there shouldn’t be any problem with

using Chai Hu. But note that it has a slightly ascending quality and
this formula is targeted for the lower jiao. Using both huang lian and
huang qin with warming herbs gives the original Hua To formula a
nice balance and makes the warmth descend and tonify the uterus.
Giving people lifestyle advice: In my classes, I talk about giving

patients lifestyle advice - meditate, maybe some nutritional guidance
and the like. It’s partly because being healthy is a lifestyle choice and
we don’t want our treatments to just compensate for the patients’
unhealthy or negative habits. Therefore, it behooves us to help them
change. It is true that there is no diet, medicine, philosophy, religion,
etc. that is best for everyone. But, doing things to promote adaption
to the environment is generally a good rule to follow. For example,
there are probably some aspects of diet that are genetic adaptations
for metabolism to local environments so change is good.
Flu season and herbs: What about advice on how to stay healthy
during flu season? If they will take herbs, Yu Ping Feng San or Tuo
Li Xiao Du Yin will offer general immune support (Yu Ping is a
modified version of Tuo Li.) People can start taking the formulas
before flu season. Our bodies are always making antibodies to fight
the flu viruses but weaker people’s immune systems may not be
able to do that well. We can start to see the body struggle before
the symptoms occur so pay attention to that. And try to be aware
of the stage of the cold. Another factor might be that if we’ve had a
particularly dry, hot summer the Lungs might produce more mucous
for their own protection. That can lead to stuffiness, congestion, and
a perfect environment for bacterial growth. Then when fall arrives
with its weather the two systems collide inside the body. This partly
explains why people have different reactions to the flu in terms of
symptoms. In Denver I see a lot of raspy, sometimes unproductive
coughs beginning in mid to late August. When the seasonal Qi
moves deeper because it is fall, that Qi mixes with the heavier

Dampness or Phlegm in the Lungs. Consequently, this seasonal
shift creates problems for patients that have not adapted well to the
change.
When the season enters Cold Dew (Han Lu) in early October,
the first wave of flu often starts. At the Taiyin depth, you can usually
easily read in the pulse that Phlegm is generating Heat. If the
movement extends further to the Blood depth it will create sinus
and throat problems. When it flares to Yangming, it will create fever
and Stomach symptoms. It seems to me that there have been few
or no superficial, exterior, or Taiyang symptoms - people are always
right in the middle of the worst symptoms by the time they come for
treatment. But like antibiotics, something like Yin Chiao San won’t
work at this point because it is for exterior conditions and the flu is
deep. We must keep track of the depth of the condition to prescribe
proper formulae.
Hypoglycemia: How would you go about telling if someone

has hypoglycemia? There might be a little thready and wiry feeling
coming from the San Jiao. If you think of thready movements as
described by the classics, they would say that it’s Cold energy. But
this is not quite Cold energy. It has a little vibration to it. What you
are feeling is actually nervous system energy going into the Spleen
at the endocrine level. At the endocrine level in the Earth/Spleen/
Stomach position is the pancreas. So what you are looking at in
this case is hypoglycemia – the patient’s blood sugar is dropping.
In order to compensate for it – look at the adrenals because the
adrenals stimulate the release of sugar, don’t they? Isn’t that how it
happens? First, you’re looking at the ambient energy available for
digestion. Second, you’re looking at a drop in blood sugar because
that’s a symptom of hypoglycemia and nervousness. When you look
at the adrenals and see how they respond, how they function in
response to the pancreas. Now you have all the players in the blood
sugar movement. If you have a problem with slow adrenals, what’s
going to happen? You already have a weak pancreas. Adrenals aren’t
responding with enough strength = the person will eat, then become
tired and sleepy because the little bit of Qi that they do have goes
to the Stomach to digest and away from the eyes; that’s what makes
them feel sleepy. So the cause of their blood sugar problem is two
pronged when looking at the pulses: we’re not only looking at the
instability and weakness of the pancreas but we’re also looking at the
adrenals that are supposed to be supporting the pancreas. If you want
to see what else their digestion is doing you can look at Gallbladder
on the left side and see if it’s wiry, if it’s full. If it is then digestion is
very active. Ask them about their diet. If it’s fatty – and if you feel
Dampness here - then suspect that there’s sluggishness building up
which means they don’t metabolize fats very well. Bile is building up,
becoming sludge, and eventually forming stones. If you see a choppy
movement in the Gallbladder position then they are developing
stones. (Time to ask someone if they have digestive distress after a
fatty meal when you feel this.)
A Conversation with Huang Di
I will leave you with this - Jim’s writing of Chapter 73 of the

Ling Shu or The Spiritual Pivot
Huang Di requested of Qi Bo, “I have heard about the nine

needles from you, the master. It is superlative and beyond counting.
I recommend that these discussions be made into one record. I will
do the recitations. You listen to the principles, for this does not
result from announcements of mine, but is from you speaking of the
primary and the way of the Dao. I command that this be done so
that it may be transmitted forever to future generations to prevent
calamity. To do this, man will have what is transmitted; without this,
man would be without these words.”
Qi Bo kowtowed repeatedly and ceremoniously said, “It is

pleasing to listen to the Dao from a sage emperor!”
Huang Di said: “The principles of using the needles, one must

know the physical form and Qi and their positions: left and right,
top and bottom, Yin and Yang, external and internal, whether Blood
and Qi are plentiful or sparse, whether movement is in counterflow
or smooth flowing, whether the Qi in coming out or entering is
tuned. Then one can plan to attack the excessive. Know how to untie
knots. Know how to tonify the hollow and to disperse the solid.
Know the upper and lower Qi doors. Be clear in penetrating the four
seas. Examine what is and its locations, Cold and Heat, exhaustion
from being soaked or ill from exposure, and the different locations
of the transporting acupuncture points. Carefully harmonize the
Qi, to know clearly the channels and tunnels, the roads of the limbs
both left and right. Know completely the meeting places. When
Cold and Heat contend, have the ability to tune and harmonize.
When hollow and solid are connected, know how to break apart
and penetrate. If left and right are not harmonized, one must grasp
the movement and know clearly whether the Qi is in counterflow or
smooth flowing. Then this knowledge can cure. Yin and Yang are not
oddities; consequently, understand the beginning and the seasons.

Examine the roots and branches. Investigate chills and fevers. Know
the locations of the evil and then the thousand needles will not be
dangerous. Know how to manage the nine needles. This completes
the Dao of needling.”
“Be clear about the five Shu points in using a slow or quick
method at their locations. Whether bending, stretching, coming
out or going in, all have their principles. When speaking of Yin and
Yang, join them with the five dynamic elements, the five viscera and
six bowels, for each also has the viscera which is his, as well as the
four seasons and eight winds to have completely the nature of Yin
and Yang.”
“Each has its positions which are enclosed at the Bright Foyer
of the nose. Each dwelling has its color and area for the five viscera
and six bowels. Examine where it is painful, left and right, high or
low. Understand the body’s being cold or warm and in what channels
it is located. Examine the skin for cold or warmth and to see if it is
slippery or rough. Know that which suffers. The diaphragm separates
an upper and lower area. Know where the body’s Qi is located. First
obtain the paths to needle sparsely, distantly to detain when deeper,
and thus be able to slowly penetrate. When there is great fever in the
upper part of the body, push it to descend. Follow the lower and the
upper to lead it away. When inspection shows the front is painful,
that must be treated first. When there is great cold in the external
parts, detain the needle and tonify. If cold has entered the middle,
follow by dispersing the sea or confluence acupuncture points. If
needling does reach it, moxibustion is then appropriate. When the
upper Qi is insufficient, “‘accumulate and follow’” by detaining the
needle. When Yin and Yang are both hollow, fire is appropriate. If
there is a perverse flow and extreme cold and the flesh to the side of
the bone is depressed and low, then cold has gone through the knee.
Treat Three Distances. If the Yin Luo channels are excessive, obtain
the Qi by detaining the needle to stop. When cold has penetrated to
the middle, “‘push and move’” the needle to scatter the evil. When
the channels are depressed and sinking, fire is appropriate at that
point. When channels are knotted firm and solid, fire is that which
will cure. Some excellent therapeutics would be missed if one did
not understand disease and pain in the two anklebone Motility
Channels. One can use a method of reversal for the lower points,
for men the Yin channel and for women the Yang channel. This is
the forbidden rule for the superior technique. This is the completion
of the essay on needling. To use the needle in practice, one must
know the rules and consequences. Above, one sees the bright lights
of Heaven. Below, one sees the seasonal administration of the eight
primary periods. In order to avoid the strange evils, one must inspect
the Hundred Families. Examine the hollow and solid to negate
the violations of evil. Thus, by obtaining the dew of Heaven, even
though encountering years of hollowness, one can be saved and not
be overcome. Reverse the suffering of misfortune. Therefore, it is said
one must know the astrological avoidances to speak about the theory
of acupuncture.”
“Act according to the laws of the ancients. Examine what may

come from what is in the present. Inspect the depths and obscurities;
penetrate without limit. The coarse doctor does not see. The excellent
doctor is honored. Not to understand the physical being is being a
spirit of disheveled hair.”
“When evil Qi attacks man, chills agitate the body, and the
primal evil attacks man. A little may be first seen in the color,
but not knowing the body it is like to be or not to be, like losing
or remaining; there is form and no form without knowing the
circumstances. There is thus the superior therapy which treats the
Qi and releases its germination and sprouting. The common therapy
handles what is already completed and originates with injury to the
body.”
“Therefore, for the techniques to use the needles, know where

the Qi is located. Protect the gates and doors. Be clear on how to
harmonize the Qi, the locations, and that which should be tonified
or dispersed, and the theory of the slow or fast needle, so that
one can treat the dwelling. To disperse, one must use the circular
method, insert and twist; the body’s Qi then will move. Quickly
insert and slowly withdraw the needle, the evil Qi then will come
out, deepen to meet, agitate the hole greatly and the Qi will come
out quickly. To tonify, one must use a square method. From the
outside draw up the skin. This point is the door. The left hand must
induce the pivot, the right hand pushes the needle to the skin, a little
twist and a slow push. It is necessary to be correct and straight, to be
tranquil and quiet, to be of firm Heart and mind, and not unraveled.
The desire should be a little detention of the needle, and then when
the Qi descends, quickly withdraw the needle. Press on the skin to
cover the outside doors. The genuine Qi then will remain. These are
the necessities of using the needle; do not forget the spirit.”
Lei Gong questioned Huang Di, ‘The Essay on the Needles’

says ‘To do this man will have what is transmitted; without this,
man would be without these words.’ What knowledge can be
transmitted?”
Huang Di said, “Individual attainment is according to the

person; conception of these possibilities causes the ability to be clear
and intelligent concerning these affairs.”
Lei Gong said, “I wish to hear about these senses and

capabilities. What are they?”
Huang Di said, “Bright eyes are responsible for the seeing of

color. Clever ears are responsible for the hearing of sounds. Smart
and quick words and speech are responsible for the transmission of
discussions and speech. Slowness with tranquility and quiet, and
the skill of the hands and the accurate judgment of Heart and mind
are responsible for the actions of acupuncture and moxibustion, the
principles of Blood and Qi and the harmonization of all that is in
counterflow or smooth flowing, as well as the examination of Yin and
Yang, together with all the methods. Slow joints and pliable muscles,
with the Heart and mind harmonized and in tune, are responsible
for guiding and leading the movements of Qi. Quick and poisonous
words and speech of the frivolous man are responsible for spit, ulcers,
and disease from curses. Withered nails and poisoned hands make
for frequent injury to affairs and are responsible for the pressure and
accumulation and restraints of rheumatism.”
“Each has and attains according to his ability. The rules which
make the actions are practical, then their names become famous.
That man who does not attain, his ability is incomplete and his
teachings are nameless. Thus it is said, ‘The man of attainment has
speech, the man who is without transmits nothing.’ This is the
meaning. If a poisoned hand is responsible, examine it by placing it
on a tortoise. Place the tortoise under a vessel and place the hand on
top. In fifty days there will be death. If the hand is sweet, there will
be a return to life as before.”
Appendix
Pulse terms from various authors
Chinese Sivin Maciocia Unschuld Wiseman Jian Jing

Chang – – extended long long
Chen sunken deep deep sunken sinking
Chi retarded slow retarded slow slow
Cu hurried hasty hasty skipping fast
Da large – large large large
Dai intermittent intermittent intermittent intermit- intermittent*
tent
Dong – – – stirred moving
Duan – – – Short short
Fu floating floating at surface floating floating
Fu – – – hidden hidden
Ge – – tympanic drumskin drumskin
Hong swollen – vast surging flooding
Hua smooth slippery smooth slippery slippery
Huan moderate – relaxed moderate normal/
moderate
Ji – – – racing urgent
Jie hesitant knotted knotty bound knotting*
Jie-suo – – untying a – unravelling
rope
Jin tense – tense tight urgent
Kou hollow – scallion scallion hollow
-stalk -stalk
Lao – – – firm firm
Que-zhou – – pecking – bird pecking
bird
Ru soft weak- soft soggy soft
floating
Ruo weak weak weak weak weak
San – – – dissipated scattered
Se rough choppy rough rough rough/
sandy/
choppy
Chinese Sivin Maciocia Unschuld Wiseman Jian Jing

Shi full full replete replete excessive
Shuo accelerated rapid accelerated rapid rapid
Tan-shi – – flicking a – stoney
stone
Wei subtle minute feeble faint delicate
Wu-lou – – leaking – leaking roof
house
Xi small fine (thin) fine fine slender
Xian strung wiry stringlike stringlike string
Xu empty empty depleted vacuous empty/
deficient
You-li – – – forceless forceless
Yu-xiang – – waving – fish tail
fish
New Additions
– – – – failing*
– – – – substitutional*
*Indicates nontraditional pulse definitions
1. Sivin N. Traditional Medicine in Contemporary China. Ann Arbor: Center for

Chinese Studies, University of Michigan, 1987.
2. Macioca G. Foundations of Chinese Medicine. London: Churchill Livingstone,
1989.
3. Unschuld P.U. Learn to Read Chinese. Brookline MA: Paradigm Publications. 2
Volumes, 1994.
4. Wiseman N. “Clinical Acupuncture and Oriental Medicine: An International
Journal,” 1999.
5. Jing J. Unpublished class notes on Dong Han pulse diagnosis, 1991.
References
Belair, Jacques, et. al. Dynamical Disease.
Capra, Fritjof. The Tao of Physics.
Dale, Ralph. Acupuncture and Emotions.
Hammer, Leon. Chinese Pulse Diagnosis: A Contemporary
Approach.
Kuriyama, Shigehisa. The Expressiveness of the Body and the
Divergence of Greek and Chinese Medicine.
Larre, Claude. The Way of Heaven: Neijing Suwen chapters 1 and
2.
Larre, Claude and Rochat de la Vallee, Elisabeth
Essence, Spirit, Blood, and Qi
The Eight Extraordinary Meridians
The Heart in Lingshu Chapter 8
The Kidneys, The Liver, The Lung, The Secret Treatise of the
Spiritual Orchid
The Seven Emotions: Psychology and Health in Ancient China
The Spleen and Stomach
Lu, Henry C. A Complete Translation of Yellow Emperor’s Classics
of Internal Medicine (Nei-Jing and Nan-Jing).
Maciocia, Giovanni. The Foundations of Chinese Medicine.
Ramholz, James. Class notes, personal and email
communications, and the following articles:
A Brief Survey of Pulse Qualities in the Pulse Positions
Commentary on Fundamental Pulse Qualities
Commentary on 5-depths
On Li Shi zhen’s Pulse Diagnosis
Ling Shu 73 and Commentary
Organs and their Associated Pulses
Pulse Waves at the Six Locations
The Normal Pulse
Sabelli, Hector, et. al. Anger, Fear, Depression, and Crime.
Satinover, Jeffrey. The Quantum Brain.
Scaer, Robert. The Body Bears the Burden.
Shou-zhong, Yang. The Pulse Classic: A Translation of the Mai
Jing by Wang Shu-he
Taylor, Mark. Implications of Complexity.

Unschuld, Paul. Huang di Nei Jing Su Wen: Nature,
Knowledge, Imagery in an Ancient Chinese Medical Text.
Unschuld, Paul. Nan-Ching: The Classic of Difficult Issues.
Li Shi zhen, Pulse Diagnosis.
Dr. Lucas can be contacted through either of her websites:

AcupunctureWoman.com
and
LucasTeachings.com
Books:
Cosmetic Acupuncture Works!: Your Guide to Cosmetic Acupuncture
for Anti-Aging
Pulse Diagnosis: Beyond Slippery and Wiry
Vanity Calamity
You don’t need Botox
Course topics:
Master Pulse Diagnosis, Treatment, and Biofeedback Mentorship
includes topics:
Treating depression, anxiety, and other emotional conditions
beginning with the pulses
Restoring balance to aid conception
Accessing the upper jiao for improved cosmetic/facial
treatments, treatment of headaches, etc.
Clinic “Grand Rounds” days for complicated patients
On fertility and cosmetic issues:

Abdominal acupuncture for treating fertility issues
Mei Zen Cosmetic Acupuncture protocols for the face and neck
Abdominal Acupuncture for weight loss and abdominal
toning

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Cover by Dancing Tornado Design

The Pulse Diagnosis: Biofeedback and Balancing System, taught

You will experience enlightenment with every patient.

Learn to become a healer .... not just a technician.

A Conversation with Huang Di - 123

Pulse Diagnosis - Biofeedback and

Being an expert diagnostician is fundamental to being an effec-

This book introduces you to the Pulse Diagnosis - Biofeedback

But for a few exceptions, pulse diagnosis is largely glossed

Historically, the original acceptance and interest in Chinese

ingly biomedical in character; it is fast becoming a subset of modern

So let’s revolutionize pulse diagnosis for the better! Pulse diag-

We all know that there are a number of pulse diagnosis systems

Pulse diagnosis can be expanded from the nine sector models

Looking at the channels in each jiao and each wrist position

The key is to physically and tactically learn what theory means

In this book I discuss pulse movements that involve:

• Exchanges between different jiaos

You will be able to show this type of information to your pa-

picture - their imbalanced picture - to compare with a picture of

You can draw them a comparison:

Here is what a normal, balanced pulse looks like:

You can show them their out-of-balance picture (above) com-

The Pulse Diagnosis - Biofeedback and Balancing System allows

I remember Jim telling me that learning a new pulse diagno-

Previously I said that I will explain how to use pulse diagnosis as

Treatment is a step-wise procedure:

pression in a way that is appropriate and correct for that individual.

In all of the pulse positions, in all of the combinations, in all

that emotions cause imbalances that lead to physical disease. In fact,

Here are a couple of cases that demonstrate how emotional

Case 1: The patient has a history of not feeling nurtured or

Another example of this type of really deep Spleen deficiency

Patients with this sort of deep emptiness in their Spleen either

Case 2: This patient has unresolved emotional trauma. This sort

Most of us Licensed Acupuncturists, Oriental Medicine Doc-

In Chinese medicine everything pertains to pulses –

Our pulses store and translate events. Everything that goes on

ways of looking at the pulses to see what happened in a person’s early

The earliest Chinese case histories talked of doctors prescribing

Historically, palpation has been considered the most important

When you look at the monographs that were written about

formal TCM education. That lack of education left us ill-prepared

Here is a case in point about a patient not being forthcoming

This case brings up a good point about how making an accurate

Looking at Different Models of Pulse

Unfortunately, American authors cannot describe or teach this level

Methods of Pulse Diagnosis

One dimensional model

The one-dimensional model is what some of us learned in

There is considerable ambiguity in a 1-D model even when it

Jing by Jim Ramholz).

It is simply not enough to only look at one thing in one position

The art is in the details ….. so is the successful treatment.

Two level or two dimensional model

The significance of the two-dimensional model is that if

To read pulses differently, we need to change our examination

An Introduction to Advanced Pulse Diagnosis Theory and Clinical

San Jiao Physical Model

Three levels or three-dimensional model (the one this system

If we view the pulse three-dimensionally, we can see it as a