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Pulse Diagnosis ~ the medical perspective

Updated: Mar 6, 2020

When you learn the ancient methods of pulse diagnosis (Chinese medicine, Ayurveda, etc), you are learning to understand the whole person, their past and future. The changes in the pulse are subtle and you cannot discern them the first time you try. These methods come from healing arts which modern science cannot comprehend, thus ignores.

But modern scientific medicine also has pulse diagnosis too, something most healers don’t learn. The view is much narrower, and I wouldn’t call it an art, but yet there’s plenty to be gained from this perspective. When you, the artist, can learn this science, I believe your work becomes much deeper.

In a previous post I covered the fast heart rate, and here I will describe the basic arrhythmias. I believe this information is vital for anyone taking the pulse and using these insights to prescribe natural therapies. But before we get to that, I’ll cover the electrical system of the heart.

Electrocardiology Basics

The heart is almost pure muscle, but not the ordinary skeletal muscle found in your arms or legs. The heart muscle fibers are all interconnected and will contract in coordinated rhythms. Think of it as the way football fans create a visual wave throughout a stadium; one individual fan raises their arms, that triggers the person next to them to do the same and this pattern propagates throughout the stadium creating the sense unity through the crowd.

When one individual muscle fiber of the heart contracts, that triggers the adjacent cells to contract, which triggers their adjacent cells and so on. Within a fraction of a second the wave of contraction has passed through the whole heart and our blood is moved with great force.

One part of the heart is supposed to start the contractions; it’s called the sinoatrial node (aka the SA node or pacemaker). The cells of the SA node are like a ticking clock keeping time for all the other muscle fibers and under normal circumstances the SA node contracts first.

The SA node will change its rate according to its environment. Drink a cup of coffee, for example, and the SA node will speed up its contractions for a few hours. Take a few slow deep breaths and its pace will slow down.

Since the nineteenth century it has been possible to measure the electrical activity using a simple device called an electrocardiogram. This will tell which part of the heart is contracting first and can give some clear insights into what is causing abnormal heart rhythms. But in most cases, these abnormal rhythms can be discerned by simply feeling the pulse. These observations can be confirmed with ECG readings from a medical office (primary care, urgent care, etc). The test is simple, non-invasive, and only takes a few minutes to administer.

The Unsteady Rhythm

A normal heart rhythm will always start from the SA node and is called “sinus rhythm.” With sinus rhythms, any changes in rate are gradual, never abrupt. Should the SA node go from 60 beats per minute to 80, first it goes to 65 beats per minute, then 70, then 75, etc. It’s never an abrupt change. Abrupt changes in rate mean that some other part of the heart has taken over (we will explore this later).

Sometimes when a person is experiencing high anxiety, the heart rate increases, slows, then increases again giving an erratic feel to the pulse. This person is often changing their breathing a lot as well (hyperventilating, breath holding, etc). That up and down heart rate, although possibly a sign of stress,* is considered insignificant from the perspective of cardiology. The medical term here is “sinus arrhythmia.” This condition is generally ignored.

The Skipped Beat

When studying the ancient forms of pulse diagnosis, the challenge is to perceive more and more subtle variations. One has to push the limits of sensory perception and ask questions like “does the pulse jump outward towards my finger, or does it beat down inward?” I imagine this to be like the violinist learning to feel the most nuanced changes on a string.

The pulse diagnosis of modern cardiology does not require such sensitivity. It’s the big changes you look for, not the subtle things. A skipped beat is one such example.

I remember my first encounter with one of these. I was holding the wrist of my client, immersed in those elusive qualities of of the pulse (depth, width, arrival, etc) when suddenly the heart seemed to stop beating, then pounded out a forceful followup beat that seemed to knock me backwards. What was that? I wondered, feeling startled. Being very naïve, I sent her to the emergency room.

What I had encountered was a classic premature ventricular contraction (PVC). This happens when heart muscle cells in one part of the heart (the ventricle) contracts early and interrupts the SA node. Back to the analogy of the wave at a sports stadium, it would be like one person trying to start a wave before everyone else is ready. Some people might follow along, but the wave doesn’t go anywhere. That false start causes everyone to take a moment, regroup, then start the wave again. With the heart, this always means missing one beat and following up with one larger beat.

Premature ventricular contractions are common and fortunately suggest nothing serious. They are a sign of stress or perhaps too much caffeine. Often exercise will eliminate them.

If a person has a lot of PVCs (i.e. one quarter of the beats for years on end) this can lead to detrimental changes in the heart, but that is uncommon. Unless they are causing palpitations or fainting, most cardiologists will not treat them.

I look at PVCs as a sign that something is out of balance. I use exercise, herbs, and nutritional strategies to try to get rid of them. I do not send people to the ER for these anymore.

Atrial Fibrillation

This heart rhythm is a little more subtle and could easily be missed. This is the rhythm of no rhythm, or in other words, irregularly irregular. The timing of each beat is completely random. Normally heart beats follow each other at regular intervals of time. For example, if a person has a heart rate of 60 beats per minute, you would expect that each beat would fall at one-second intervals (evenly paced). But with atrial fibrillation (AF), it’s chaos. It’s like popcorn popping, you never know when the next beat will happen.

The problem with atrial fibrillation is that the randomness of the contractions will cause stagnation of blood within the heart. This stagnant blood can form a clot. The clot can move into circulation becoming lodged in the brain (stroke) or lungs (pulmonary embolism). It is for this reason people are usually treated with blood thinners when they are having AF. Often blood thinners are the only treatment given and the plan is to to simply wait until the AF stops.

I have seen AF immediately and spontaneously resolve after homeopathic and herbal treatment. I’ve heard the same of acupuncture treatments. So yes, AF sometimes responds to natural treatment, but you cannot count on that.

It is for this reason that I would not give treatment unless the client commits to following up with a cardiologist or primary care doctor within the next week. If the natural treatments worked and there’s no longer AF, everything’s fine. But if it’s still there, a blood thinner should be considered by the client and their doctor.

Once a person starts taking a blood thinner, it is unsafe to use material doses of herbs and nutritional products (homeopathic potencies and acupuncture is fine).

Ventricular Tachycardia

This one will feel like a sudden burst of very fast heart beats.

While there are many things which can cause fast heart rates (see my post which covers this), what makes ventricular tachycardia (VT) stand out is that the heart will suddenly and abruptly change pace. The heart rate might be 80 beats per minute, then as though a switch was flicked, it is racing at 120. The abruptness of the change tells you that the SA node is not in control.

This is the most dangerous heart rhythm I could imagine a practitioner encountering. It’s not common, but requires prompt medical evaluation.

The problem with VT is that it can lead to a condition called ventricular fibrillation which is often fatal. Again, it’s not common, but I think it’s worth going over some strategy to prepare for such an encounter.

If a person is suspected of having VTs, this will need to be verified with an ECG. The problem with the typical ECG (as offered in emergency rooms) is that it will only measure the heart for a few seconds. Ventricular tachycardia is a condition which comes and goes, so the emergency room might miss it. Therefore, the best way to test for VT is to have a person wear a special electrocardiogram called a Holter monitor.

Of course, unless you are a licensed doctor, you cannot actually prescribe this device. There are wearable ECG devices on the market (such as at the Apple watch), but these will be of no use here. To detect VT it must be a medical Holter monitor.

I’ve only seen this pulse pattern one time. In this situation, I told her to call her medical doctor (the same day) and ask to be put on a monitor. It all worked out fine and although she did not have VT, it did turn out she had a different rhythm abnormality which was mimicking VT. Had her primary care doctor not been so cooperative, I would have called other medical offices and asked for their help. I think that’s the best one can do if you’re working outside of the medical system. If that doesn’t work, try the ER. But either way, get them tested same day.


I know for healers it is easy to feel lost and alone when faced with medical conditions you don’t understand. Usually institutions of medicine will offer little support, even condemnation towards outsiders. This makes it all the more important to learn the science of medicine, even if your methods predate modern science.

It is for these reasons that I now offer classes in pathology to students and practitioners of the healing arts. These classes are designed to be accessible to anyone, regardless of education.

Please visit my website to learn more about webinars and workshops.

*There is another version sinus arrhythmia recognized as a sign of health. It’s called “coherence.” This is a changing heart rate, a rising and falling, which coincides with rise and fall of each breath. If your heart beats faster each time you inhale, then slows as you exhale, it is likely that your heart and mind are in good shape.

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