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Location and method of
constitutional pulse taking
Constitutional pulse taking follows the ancient theory of the
attribution of the organs, but is different from traditional pulse taking in
location and method.
The traditional place to take a pulse is the radial artery above the wrist,
divided into three regions: cun, guan, and chi. The middle
finger is put onto the styloid process (small bump) of the radial artery; this
region is guan. The pointer finger and ring finger are put next to it.
The region of the pointer finger is cun and the ring finger region is
chi.
Traditional pulse taking Constitutional pulse taking
Illustration
28. Traditional and constitutional methods of taking a pulse
But the place for constitutional pulse taking is different.
Firstly, constitutional pulse taking is done not on both hands, but only on the
left hand. I will explain the reason later. For constitutional pulse taking,
the three fingers are put onto the left hand regions cun, guan
and chi a little farther up the arm (closer to the elbow) than for
traditional pulse taking. In other words, the region chi in traditional
pulse taking is the cun region in constitutional pulse taking. This is
to avoid the styloid process of the radial artery.
In traditional pulse taking the state and feeling of the pulse is important, so
the styloid process of the guan region isn't important. But in constitutional
pulse taking the goal is not to determine the feeling of the pulse, but to find
out on which of the three regions the pulse beat is strongest. Therefore the
three fingers must be put evenly on the level radial artery without including
the styloid process.
 
Illustration. Positions of traditional (left) and constitutional (right) pulse taking
If the patient has a long arm, the practitioner should put his
fingers apart proportionally. If the patient has a short arm, the fingers
should be put closer together. When taking the pulse with the three fingers,
the pressure on the artery can differ among the three fingers because of their
different lengths, but to get an accurate pulse reading, it is very important
that the three fingers be applied with equal pressure.
In traditional pulse taking, the fingers slowly increase their
pressure to feel the raising and lowering of the pulse, but in constitutional
pulse taking the fingers from the start are pressed with maximum pressure until
the pulse is no longer felt. Such is the difference. The fingers are pressed
hard enough that the patient feels pain from the strong pressure and fingernail
marks are left on his forearm.
In order to press that hard, the patient's forearm is not put onto a table as
with traditional pulse taking, but lifted from the wrist vertically. One can
apply much more pressure when one pulls the vertically raised forearm of the
patient than when one presses down onto his forearm while it lays on a flat
table.
Illustration. Taking the pulse at a table
Pull the patient's left palm a little toward yourself with your
left hand and hold it firmly, then press hard at a right angle on the pulse
regions with the three fingers of your right hand. It is important to press not
only the artery, but to put the three fingers onto the ligament the goes
through the middle of the wrist and press them as if you were pulling them in
the direction of the artery.
Illustration. Taking a pulse with the patient in bed
In summary, in traditional pulse taking the goal is to find out
what kind of pulse is beating, but in constitutional pulse taking the goal is
simply to find out in which of the three regions cun, guan, and
chi the pulse is beating.
If the three fingers are applied with light pressure as with traditional pulse
taking, all three fingers will feel a pulse. It wouldn't be possible to know,
then, in which region exactly it's beating. Therefore in constitutional pulse
taking, the fingers are pressed very hard, until all pulses in the three
regions cun, guan, and chi are gone. Because of the heavy
pressure, there comes a moment when no pulse can still be felt. If the fingers
are left in place for several seconds after reaching that point, they can feel
the pulse that sprays out of one of the three regions like a fountain.
If you feel a pulse in one of the three regions, you are halfway through the
constitutional pulse taking. It is this pulse that indicates the state of the
organs according to the constitution. If a patient is teumin with large liver
and small lungs, the liver pulse beats strongest in the guan region. If
a patient is soumin with large kidneys and small pancreas, the kidney pulse
beats strongest in the chi region.
That is an evident fact proven by
experience.
The amazing thing is that constitutional pulse remains completely unchanged
with time and condition. If today you feel the pulse in a different region than
yesterday, that is caused by an error in taking the pulse. If one becomes
skillful in taking the pulse, the result is always the same, a year from now or
even with a serious illness. According to the organ structure the largest organ
appears as the constitutional pulse and this organ structure absolutely does
not change, the same as the constitution itself.
He who doubts the existence of such a constitutional pulse can try it for
himself following the instructions above, and he can find the answer.
He whose constitutional pulse beats in the cun region is soyangin.
He whose constitutional pulse beats in the guan region is teumin.
He whose constitutional pulse beats in the chi region is soumin.
Illustration. Constitutional pulse in the regions cun, guan and chi
The three constitutions soyangin, teumin and soumin can be
distinguished by insufficient and excess syndromes of the three organs heart,
liver and kidneys, which are attributed to the left hand regions cun,
guan and chi.
He whose heart pulse is strongest on the left hand cun region is
regarded as soyangin. Because the heart is in the upper middle jiao along with
pancreas according to the four jiao theory of Lee Jema, and because soyangin
has the strongest fire of the four constitutions.
He whose liver pulse is strongest in the left hand guan region is
regarded as teumin. Because teumin has the largest liver and its pulse shows up
in the left hand guan region.
He whose kidney pulse is strongest in the left hand chi
region is regarded as soumin. Because soumin has the largest kidneys and their
pulse shows up in the left hand chi region.
Teyangin has the largest lungs and its pulse shows up in the left hand cun
region. Therefore, in contrast to the other constitutions, it is not possible
to distinguish teyangin only by taking the pulse on the left hand.
Lungs and pancreas are attributed to the right hand cun and guan
regions. Naturally the constitutional pulses of teyangin with large lungs and
of soyangin with large pancreas show up on the right hand. In that case it is
necessary to take a constitutional pulse on both hands.
Why then do we take the pulse only on the left hand to determine the
constitution?
Because the pulse is stronger and more easily felt on the left
hand than on the right. This reason can be attributed to the fact that the left
hand blood circulation is stronger because it is closer to the heart, and to
the fact that according to Chinese medicine theory the left side is strong
while the right is weak, and to the fact that according to the theory of five
elements, the three left hand pulse regions control those of the right hand.
But there are more important reasons:
Firstly, in practice it is difficult to choose the strongest pulse out of all
six pulses of both hands. For example, the strongest pulse on the left hand is
in the guan region, and on the right hand is in the chi region.
It would be necessary to definitely judge which of the two pulses is strongest.
In that case, the practitioner stimulates the right hand of the patient with
his left hand and the patient's left hand with his right hand. It isn't easy to
judge which pulse is stronger, because the position of the practitioner and the
strength of his two hands are different.
Secondly, it is possible to determine the constitution by taking only the three
pulses of the heart, liver and kidneys on the left hand. Even though one can't
determine a teyangin on the left hand, the left hand pulse taking is a very
effective way to determine a soyangin, teumin, or soumin. If one were to take
the pulse only on the right hand, it wouldn't be possible to distinguish teumin
and soumin, which are much more numerous than teyangin.
As stated above, through constitutional pulse taking one doesn't determine all
eight constitutions, but only the three constitutions soyangin, soumin and
teumin. To subdivide them respectively into the first and second types, one
must observe the body shape.
For example, He whose pulse is strongest in the
left hand cun region is regarded as soyangin. If he is corpulent or with well
evolved shoulders, he is regarded as first soyangin. If his build isn't
relatively stocky and shoulders aren't especially well developed, he is
regarded as a second soyangin.
If we have learned well the body shapes of the eight constitutions in the
previous chapter, it is easy for us to distinguish the first type from the
second, once we have decided on one of the four constitutions by taking the
pulse. In fact, constitutional pulse taking on the left hand is much easier
than taking the pulse on both hands, but to learn that from personal experience
isn't as simple and easy as one might think.
The most frequent difficulty in constitutional pulse taking is that the pulse
is felt in different regions each time it is taken. For example, the first time
the pulse is felt in the cun region, but the second time it is felt in
the guan region.
Then it is difficult to judge which pulse is the right
one. This is caused by not having the same pressure on each of the three
fingers.
If one is skillful at taking constitutional pulses, one will always
feel the same pulse exactly. The novice must practice with that goal in mind.
Another difficulty is in distinguishing a pulse that beats between the cun,
guan and chi regions. For example, if one feels a pulse between the
cun and guan regions or between the guan and chi
regions, it is hard to decide which pulse it is. It may happen that the pulse
begins to beat in the guan region but after a while moves over to the
cun region. It is also possible, that no pulse is felt in any of the
regions.
Such difficulties confuse the student of pulse taking,
but are definitely to be defeated. Experience in taking the pulse and ability
to interpret various pulses are acquired so that in the end the student becomes
skillful in taking pulses.
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