It takes a young medical student a few grains of sesame seed and sheets of paper to practice good pulse taking. First cover the seeds with one layer of paper and feel it. Then cover it with another sheet of paper and then another after feeling the differences. As the layers thicken, the opposite happens to our nerves. We must be very attentive and the fingertips must be extra sensitive. Try feeling a pulse that is like silk thread with calloused hands!

Taking the pulse is one of the methods in diagnosing a disease. It requires great concentration to fish out the subtle differences in a persons pulse. Subtle though are the differences they point at divergent diseases, which makes pulse taking a very important step in diagnosis. Of the 28 pulses that is the standard classification, some doctors only distinguish the speed, depth, and size of the patient's pulse, but more exact diagnosis can be expected when all the different pulses are considered.

Of course, pulse varies in different types of persons, e.g. male and female, old and young, fat and skinny. Usually women and children's pulse tend to be faster than men's. Taking a woman's pulse can be more complicated if she is having her period or carrying a baby. Fat patients are usually people with a lot of Dampness and Phlegm and it can be difficult to feel their pulse owing to the thick layer of fat. Waiting a minute or so for the fat layer to slide off can help. The doctor must be calm when taking a pulse and the patient should be in a stable state also, for one's typical pulse to be felt. A few minutes of rest is ideal before taking the pulse in a normal situation, and 24 hours must pass after drinking alcohol. Thirty minutes to four hours are needed for the patient's pulse to come back to its original state if the patient takes in caffeine or tranquilizer.

The pulse is usually taken at one's wrist. The examiner places the index, middle and ring fingers on the patient's inner forearm starting from the little notch beneath the fold of wrist. (The pulse is not taken with the thumb because the thumb has its own pulse.) Sometimes there are patients with a pulse that is felt on the back of one's hand instead of the inner wrist, and they are probably undergoing physical or mental stress. Not all pulse taking takes place on the wrist, like feeling the pulse on a specific acupoint to know the convalescence of the heart. A very strong pulse is felt under one's neck, and by comparing the strength with the pulse at the wrist a doctor can infer the patient's lack or oversupply of Ki and Blood.

To be an accurate examiner of the pulse one has to take a lot of pulse, especially those of health people. A normal pulse is neither floating nor sinking, not slow nor fast, it is not slippery nor is it rough and choppy. The 28 pulses are "disease pulse," those that are felt during an illness. By the depth of one's pulse the doctor knows the place of the disease: the exterior or interior of the body. Speed signifies the presence of Heat. A rapid pulse means there is Heat in the patient's body. The texture of one's pulse is very important. When there is a lot of phlegm in the body a slippery pulse is felt, and the opposite -a choppy pulse- is felt in case of inflammation due to coagulation of the blood.

A slippery pulse feels like the skin of a potato with a plastic bag over it. It could be felt when there is inflammation of the lymphatic vessels or at times of arthritis, like when pathologic fluids start filling in the knees. A slippery pulse is also felt on children with high fever, and it is seen as a problem of the digestive organs. Sexual drive is expressed in a slippery pulse which is also the pregnant pulse. At the time of conception the pulse feels like a rough brush that is used to dust off dirt from shoes. It is a choppy pulse. The pulse turn from choppy to slippery because the early stage of pregnancy is similar to an inflammation of the uterus. To elaborate, the choppy pulse feels like touching unrefined barley. It is present during a woman's menstrual period. Other diseases this pulse imply are pernicious anemia, appendicitis, inflammation of the gall bladder and other inflammations related to nervousness. Insufficient Eum is manifested in the choppy pulse, therefore in case of inflammation the choppy pulse occurs with a rapid pulse. When the body contacts toxic liquids or venom from snake or insects, one's pulse turns choppy.

There are two very tight pulses. A wiry pulse feels like the string of a guitar because of the constricted blood vessel. The squeaky feel of the surface of glass is similar to this pulse. Three circumstances that the wiry pulse is shown are: acute pain like gastralgia or bilestone, physical and mental strain, and liver disorder. Obviously the other tight pulse is "tight" pulse. A tight pulse is the tighter and rougher of the two. It feels like touching a straw rope or pressing the center of a drum. A tight pulse means there are obstacles in the blood vessel, like cholesterol or phlegm and coagulated blood. According to shanghan theory, it is the pulse that accompanies high fever. When a person's metabolism is down or one is exhausted, usually with high blood pressure, tight pulse is felt. Both with wiry and tight pulses turn into the full pulse, which means that blood is jammed in the vessels. High blood pressure and sclerosis of the arteries are shown through a full pulse.

The following pulses are ones that are not felt as often as the pulses mentioned above, but a good doctor should distinguish them.

A confined pulse and hidden pulse are both deep pulses but whereas the former one is strong, the latter is weak.

A moderate pulse is the normal pulse on a healthy person, but sometimes it can mean the existence of Dampness in an obese person. Also when a person has too many thoughts this pulse is felt. That is why it is on occasions call the "lovesickness pulse." A frail pulse is weaker than the moderate pulse because there is less Ki and Blood. A minute pulse is a frail pulse that is broken off at times.

A soggy pulse pulsates but cannot be held, for it is absorbed in the examiner's hand. The pulse also beats at two or three places. It is the pulse that appears before death when Ki and Blood is greatly lost.

Bodily fluid is lacking in a thin pulse. It feels like the touch of a silk thread or the blade of a shaving knife. Blood rather than Ki is insufficient.

Similar pulses with different elasticity are empty and hollow pulses. The empty pulse has elasticity on the surface but not inside. It is like the moderate pulse but feels like there is air inside, flaccid like a deflated balloon. The hollow pulse is like wiry pulse with air inside. It is described as a pulse that feels like the stem of a green onion, which is hollow in the middle. Loss of blood, extreme dehydration leads to this pulse as well as sexual overactivity.

The length of a pulse gives the state of Ki and Blood. When Ki is sufficient but Blood is lacking, a long pulse lets you know to nourish the Eum. You should aid the Ki when a short pulse is felt for it means Ki is insufficient.

Irregular pulses include hurried, knotted, and intermittent pulses.

<See Characteristics and Clinical Significance of Various Pulses for more information on the 28 pulses.>

Pulse taking is a vital part in diagnosing the patient's disease. The importance of this step in deciding a person's physical condition is evident in the expression "going to have one's pulse taken" which is equivalent to "going to see the doctor." All 28 pulses (which is only one type of classification of pulses) are difficult to tell. But by distinguishing the exact pulse a good doctor can diagnose a correct disease and cure it effectively. Pulse taking is a very useful technique for the doctor because it lets us know the conditions of internal organs and the harmony between them without heavy machinery. It can be done any where, any time with only a doctor's talent. Bian Que (Korean pronunciation: Pyeon Jak), the ancient doctor who started the field of pulse taking, was said to have clairvoyant powers because he knew what was going on inside the patient's body so well. There is a watercolor painting of him feeling his own pulse. A white haired old man in blue robes with long grown nails. (Many paintings of Taoists in those era have long finger and toe nails, probably because they did not have nail clippers then.) In order to be extra sensitive at the finger tips when taking a pulse, we need to clip nails short. But it is the old man's spirit that communicates with the atmosphere of the universe, that shines through his innocent smile, we are to take after. In the <Neijing>, from where Bian Que adopted his <Nanjing>, the validity of diagnosing with the pulse is explained by saying, "one's pulse is connected with the heaven and earth."