Why Do I Take Your Pulse During an Acupuncture Treatment?

If you’ve had an acupuncture treatment with me, you’ve probably noticed that I take your pulse multiple times during a treatment. You might assume I’m simply checking your heart rate. While heart rate is certainly something that can be observed from the pulse, in Traditional Chinese Medicine (TCM), pulse assessment is much more involved.

Pulse diagnosis in Chinese Medicine

Pulse diagnosis is one of the traditional assessment methods used in TCM. Rather than looking at one isolated measurement, the practitioner pays attention to several characteristics of the pulse, including its rate, depth, strength, width, rhythm and overall quality.

A commonly taught framework describes 28 different pulse qualities. The terminology can sound pretty unfamiliar at first some pulses are described as floating, deep, wiry, slippery, rough, thin, rapid, slow and so on.

These aren't simply different versions of a normal medical pulse. Within TCM, the qualities are interpreted in combination with the person's symptoms, history, tongue, presentation and other findings.

The pulse is also assessed at three positions on each wrist: cun, guan and chi. Traditionally, these positions are associated with different organ systems and aspects of the body's functioning. This is an important distinction: when a TCM practitioner talks about an “organ” in relation to the pulse, they aren't necessarily talking about the anatomical organ in the same way Western medicine does. I don't take your pulse and think, “Your liver is having a problem.”

Instead, I’m looking at the pulse as another source of information about patterns and relationships within the body as a whole.

Why take the pulse during treatment?

This is actually one of my favourite parts of pulse diagnosis. The pulse isn't necessarily static. During an acupuncture treatment, I can reassess the pulse and notice changes in its depth, strength, rate or overall quality. Within the TCM framework, these changes can provide feedback about how the body is responding to the treatment. It's a little like getting another piece of information in real time.

I'm not relying on the pulse alone to decide what I'm going to do. It's considered alongside your symptoms, movement, presentation and the other information I gather during your assessment. But when the pulse changes during a treatment, it can be useful feedback that helps guide what I do next.

Am I a pulse-taking expert?

I'll be honest: no.

I first learned pulse diagnosis almost 10 years ago when I was in school. Like many hands-on clinical skills, it's something that takes years of repetition and experience to develop.

You can learn the theory from a textbook, but recognizing subtle differences between pulse qualities comes from putting your hands on a lot of wrists and learning what those descriptions actually feel like.

My pulse-taking skills have come a long way since I first learned them, and I'm still learning.

That's part of what I enjoy about acupuncture and Chinese Medicine. There is always another layer of observation, another subtlety to notice and another piece of information that can help build the clinical picture.

So the next time I take your pulse and spend a little longer than you expected, I'm not just counting your heartbeats. I'm listening with my hands.