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“I very much appreciate Dr. Chang's willingness and ability to convey his knowledge. It seems the next best thing to apprenticeship.” B.W.

“It's amazing how confident I feel after attending Dr. Chang's classes. There's a giant leap in the learning curve that translates to better prescribing. My patients are happy and very grateful when they see results!!! For me, always new pearls of wisdom. Thank you.” K.V.

BASICS OF CHANG'S PULSE DIAGNOSIS AND
HERBAL PRESCRIPTION

By Jimmy Wei-Yen Chang, L.Ac.

PULSE TAKING BASICS

After placing your fingers on the correct positions, one should palpate from the side of the patient. At first touch, the pressure should be very light with gradual increase in pressure, but try to avoid direct contact with the tendons and bones surrounding the vessel. The finger pads should apply from light to heavy pressure while searching the vessel. Most distinct upon light palpation is the floating/superficial aspect of the pulse and most distinct upon heavy pressure is the deep aspect of the pulse. The pulse’s center is located between light and heavy pressure - feel for it with the finger pads.

WHAT TO FEEL

As the fingers examine the Cun, Guan and Chi, attention should be focused on two aspects of the vessel – Jump and Shape. Jump refers to the pulsation aspect of the vessel and primarily takes into account its energetic aspects in terms of rate, strength and quality. Shape refers particularly to the vessel’s form and primarily takes into account its structural aspects. For example, the Jump for a pure excess heat pulse is fast and forceful while the Shape is thick and convex. Conversely, the Jump for a deficient cold pulse is weak and slow while the Shape is thin and concave.

Table of Jumps
	Yin	Yang
Rate	Slow	Fast
Strength	Weak	Strong
Quality	Stagnating	Flowing


Table of Shapes
	Yin	Yang
Width of vessel	Thin	Thick
Depth	Deep	Floating
Resistance	Soft	Hard
Topography	Concave	Convex


Note: Floating/superficial pulse in Chang’s Pulse Diagnosis does NOT necessarily indicate an exterior condition. When the pulse can be felt at the superficial level, excess heat is indicated as the vessels are being expanded by the extra force and pressure. This idea is contrary to the traditional belief that exterior syndrome will reflect in superficial pulse. Wei-Yen Chang explains that patients who suffer from high blood pressure, systemic inflammation or infection will manifest a pulse that can be felt at the superficial level on all three positions. He explains that the only time a superficial pulse means an exterior condition is when it’s detected on the right Cun (Lung) position. In all other cases of superficial pulse, an exterior condition is not indicated.

HERBAL PRESCRIPTION STRATEGIES

It is impossible to describe in a few paragraphs all of Chang’s herbal prescription strategies. A few basic and advanced tips will be described here to help you prescribe for those patients whose conditions you might not know what herbal formulation(s) to give.

The first and most basic principle is to use tonic herbs for patients who show weak, deep and soft pulses. These pulses indicate deficiency. In order to revitalize the pulse, tonic herbs should be used.

Second is using heat-clearing herbs for pulses that are fast, strong and convex. These pulses indicate heat accumulation, so heat-clearing herbs are to be used to help return the pulses to its normal beat.

The third strategy is more advanced. Thick pulses indicate an expanding condition. An expanding condition translates to heat accumulation with inflammation and swelling. Both heat-clearing and astringent herbs should be used to reduce and shrink the expansion. Heat-clearing herbs should occupy a major portion of the herbal formula while astringent herbs occupy the minority. If you were prescribing raw herbs, heat-clearing herbs would be the king/chief and deputy herbs. If you were prescribing herbal extract powder like Wei-Yen Chang, the heat-clearing herbs would occupy 70% of the formula while the astringent herbs 30%.

Some practitioners may think the heat clearing principle makes sense but not the astringent portion. As learned in school, astringent herbs are contraindicated for heat or excess condition. It is reserved for deficient patients with prolapse or leakage. Chang explains this advanced use of herbs by giving an example of an asthma patient. In an asthma patient suffering from an acute excess heat attack of the lungs, the symptoms will be dyspnea, wheezing, yellow mucous, and chest congestion and so on. The pulse will most likely be forceful and expanding. Forceful indicates heat while expanding indicates an excess and inflammatory condition. Besides bronchial constriction, an asthma patient also suffers from hypertrophy of the surrounding tissues in the lung, swelling, airway edema, mucus accumulation and inflammation. So while the treatment principle is to dilate the airway using herbs such as Ma Huang (Herba Ephedrae) and clear heat by using herbs such as Shi Gao (Gypsum Fibrosum), traditional textbooks never mention using astringent herbs to help manage the hypertrophy, swelling and airway edema. As much as bronchodilators will help expand the airway, if the surrounding tissues are still very inflamed and swollen, how can the bronchial tubes dilate? Therefore, a small percentage of astringent herbs will help tremendously with the overall effect of the formula. The key is NOT to use it as the chief/king herb in a formula, but rather as a supporting herb to maximize the overall effect. Two of Wei-Yen Chang’s favorite herbs to use are Wu Bei Zi (Galla Chinensis) and He Zi (Fructus Chebulae).

This principle of using small portions of astringent herbs applies to all swelling conditions with expanding pulses. Such conditions can include gout and hypertrophic rhinitis, among others.

The last example is the use of blood moving herbs for sluggish pulses. In such cases of stagnation, blood-moving herbs are necessary to unblock the obstruction. Wei-Yen Chang likes to use the combination of Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction), Ge Xia Zhu Yu Tang (Drive Out Blood Stasis Below the Diaphragm Decoction) and Shao Fu Zhu Yu Tang (Drive Out Blood Stasis in the Lower Abdomen Decoction) together. Some practitioners may disagree with this type of herbal usage as the total number of single herbs may exceed 30. Wei-Yen Chang does this for two reasons.

First he uses extract powders so when he combines three formulas, he is essentially combining the effects of the three formulas rather than the ingredients of the three formulas. Many Taiwanese practitioners combine multiple formulas because the formulas are cooked together and then extracted into the powder form.

Second, as he teaches in his classes, using blood movers is much like trying to ventilate a car. If the air feels stagnated on the driver’s side, one can simply open the driver side’s window. Similarly, when the upper jiao has stagnation, Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction) can be used to move the blood in the upper jiao. However, going back to the example of the car, if one wants to quickly ventilate the car, the fastest way is to open all the windows to optimize air circulation. Similarly in the body, using one formula for the upper jiao is much like opening one window. Using three formulas, one for each jiao of the body will enhance your overall effect of the formula. This type of herbal combination follows the prescription idea of Xiang Xu (mutual accentuation) where herbs are used together to amplify the overall therapeutic effect.

ABOUT THE AUTHOR

Jimmy Wei-Yen Chang, L.Ac.

Master Jimmy Wei-Yen Chang has over 25 years of concentrated clinical experience applying his expertise in differential diagnosis and herbal prescription. The author of a pulse diagnosis manual, Pulsynergy, Master Chang currently pursues his specialties in private practice in Hacienda Heights, California, and is widely recognized for his skills in correlating expert pulse taking and herbal prescription.

To learn more about pulses and herbs, Jimmy Chang is speaking on the following topics for Lotus Institute. All classes are approved for 8 CEUs/PDAs by the California Acupuncture Board and NCCAOM.

CLASSES BY THE AUTHOR

Treatment of Gastrointestinal & Hepatic Disorders

2/24/08 Anaheim, CA

Women’s Health & Infertility

6/1/08 Denver, CO

Fang Jia Fang – The Art and Science of Herbal Combinations (Part I)

3/16/08 San Francisco, CA

Fang Jia Fang – The Art and Science of Herbal Combinations (Part II)

7/27/08 Oakland, CA

Revolutionary Pulse Diagnosis (Part I) (30 attendees max.)

10/5/08 Rowland Heights, CA

Revolutionary Pulse Diagnosis (Part II) (30 attendees max.)

11/23/08 Rowland Heights, CA