How fast is a fast pulse -- really?

[Guest guest]

Hi All, & Michael,

 

Michael Tierra wrote:

> When i first learned pulses a fast pulse was 80BPM and above. Now i

> notice that it is 90BPM and above. John Shen also said it was 82 BPM

> and above. My experience is that 90 BPM is really fast and for most

> people 80 BPM or above is a good criteria for a rapid pulse. Any thoughts?

 

Michael, I am glad that you raised this question because I am confused

about the definition also.

 

Some sources define a pulse as slow or fast RELATIVE to breathing rate,

agreeing with Bob Flaws' guideline that 4-5 beats per breath is a normal

pulse rate:

 

(a) http://tinyurl.com/2pm8gz [The Secret of Pulse Diagnosis by Bob Flaws]

says:

 

>5 beats per breath is fast pulse (or >90 BPM )

<4 beats per breath is slow pulse (or <60 BPM)

 

(b) http://tinyurl.com/2s8yso [Acupuncture: Treatment of Musculoskeletal

Conditions by Christopher M. Norris] says:

 

>5 beats per breath is fast pulse

<4 beats per breath is slow pulse

 

http://tinyurl.com/32h6r4 [Practical Diagnosis in Traditional Chinese

Medicine by T'ieh-t'ao Teng & Kevin Ergil] says:

 

>5 beats per breath is fast pulse

<4 beats per breath is slow pulse

 

http://tinyurl.com/2tqf6d [Feeling the Pulse by altmed.iatp.org.ua ] says:

 

>5 beats per breath is fast pulse (or >90 BPM )

<4 beats per breath is slow pulse (or <60 BPM)

 

http://tinyurl.com/3bdbot [sacred Lotus page] says

 

>5 beats per breath is fast pulse (or >90 BPM )

<4 beats per breath is slow pulse (or <60 BPM) relative to

PRACTITIONER's breath!

 

However, some sources disagree with the definitions above. For example,

 

http://tinyurl.com/3dt6au [Commentary on Li Shi Zhen's " Pulse Diagnosis " by

James Ramholz] says:

 

The normal or balanced pulse is 4 beats per breath

>4 beats per breath is fast pulse

<2 beats per breath is slow pulse

 

A pulse can become Rapid due to a " deficiency of yin and an excess of

yang " energy. The Slow pulse results from " a deficiency of yang and an

excess of yin " (22). In general, the Slow pulse indicates cold energy and

Rapid pulse indicates hot energy. If the pulse moves faster than 6 beats or

slower than 2 it is an extremely critical sign, usually indicative of death;

yang

and yin no longer communicate with each other and are about to be cut.

 

http://tinyurl.com/2wselq (Diagnosis in : A Comprehensive

Guide by Giovanni Maciocia) says:

 

>4 beats per breath is fast pulse (or >82 BPM )

<4 beats per breath is slow pulse

 

That infers that the normal pulse rate is 4 BPS, with no range allowed!

 

Macioccia stresses that NORMAL pulse rate changes with age and other

factors; as NORMAL rates, he gives:

 

0-1 years old 120-140BPM

1-3 years old 110

4-10 years old 84-90

11-15 years old 78-80

16-35 years old 76

36-50 years old 70-72

50+ years old 68

 

So, I am as confused as ever, but think that Bob Flaws is about right.

 

That gives me a problem, because I have had for many years a slow

breathing rate and a pulse / breath ratio of between 7/1 and 10 to 1.

 

By that reckoning, I should have died years ago!

 

Best regards,

 

 

 

 

[Guest guest]

Phil,

 

This question is a good one in terms of basic information gathering

and analysis. The question quickly becomes (or should become)

" according to whom? " Whenever there is a variety of opinions on a

topic, one needs to first become aware (through wide reading and

research) of as many of those opinions as possible. Then one has to

weigh those opinions, one against the other. Not all opinions are

equally valid or credible. Now the question becomes, " How does one

weigh an opinion? " Unfortunately, there's not one single method.

However, some of the criteria for making such a judgment include (but

are not limited to):

 

1. The number and credibility of different authorities who

to a particular opinion. In other words, how much of a consensus does

a particular opinion enjoy

2. When and why the opinion came into vogue or was promulgated

3. The " shelf-life " or age and time-tested nature of the opinion

4. Empirical evidence presented for and against the opinion (Of

course, then one has to examine that evidence and its credibility.)

5. A review of the various opinion-holders/proponents' credentials.

Just as not all opinions are equally valid, some peoples' opinions are

worth more serious consideration than others because of such factors

as (when it comes of CM):

 

A. Number of years in practice

B. i) Type, duration, place of entry-level education, ii) type

duration, place of subsequent education, including the credibility of

the opinion-holders' teachers/trainers

C. Identifiable biases based on sex, age, ethnicity, education,

experience, politics, religion, philosophical position, etc., etc.,

etc. which might affect the credibility of the opinion

D. General credibility of the body of their work

E. Ability to access important source materials which might affect the

opinion in question, e.g. the ability to read Chinese (or other East

Asian language)

G. Individual intelligence and insight (or genius)

 

Unfortunately, this is not the kind of mature judgment-making taught

at most of our schools and colleges. Therefore, all too often, the

answer is either doctrinaire (It is what it is because I say so) or is

universally relative (Whatever; suit yourself; there is no right answer).

 

As an extension of this, this is why one needs to read the

" bibliographic " page at the front of books (when published, when

revised, etc.) as well as the bibliography at the end. Without taking

those things into account, one cannot really assess the materials

contained in a book or article. That's why scholarly books include

bibliographies. Otherwise, all opinions may seem to be equally valid.

[Guest guest]

Sounds a little like the kind of judgment and independent thought I've been

trying to inject into our discussion that has met with so much orthodox

resistance. I certainly know from my experience when a pulse is fast or not

and I can't remember when a pulse of 90 BPM without some physical exertion

was normal for any patient seeking my assistance. Its not 'traditional' to

use a timepiece to evaluate the speed of the pulse as opposed to counting

breaths but it sure is a lot move easier and convenient -- something lost,

something gained-- what one loses is the time spent knowing the patient,

getting close to the paradox of their existence which I think is ultimately

the true definition of CM diagnosis.

 

One of the aphorisms I remember learning back in the 70's was that a patient

is sick when they think they are and well when they think they are. So we

are all sick and we are all offering the best compromise i.e. collection of

balances and imbalances for our existence. It is only when someone wants to

make a change that the signs and symptoms come to represent their unique

'growing edge' and become tools for our helping them to facilitate those

changes.

 

Michael Tierra

 

 

_____

 

 

On Behalf Of Bob Flaws

Thursday, February 14, 2008 12:32 PM

 

Re: How fast is a fast pulse -- really?

 

 

 

Phil,

 

This question is a good one in terms of basic information gathering

and analysis. The question quickly becomes (or should become)

" according to whom? " Whenever there is a variety of opinions on a

topic, one needs to first become aware (through wide reading and

research) of as many of those opinions as possible. Then one has to

weigh those opinions, one against the other. Not all opinions are

equally valid or credible. Now the question becomes, " How does one

weigh an opinion? " Unfortunately, there's not one single method.

However, some of the criteria for making such a judgment include (but

are not limited to):

 

1. The number and credibility of different authorities who

to a particular opinion. In other words, how much of a consensus does

a particular opinion enjoy

2. When and why the opinion came into vogue or was promulgated

3. The " shelf-life " or age and time-tested nature of the opinion

4. Empirical evidence presented for and against the opinion (Of

course, then one has to examine that evidence and its credibility.)

5. A review of the various opinion-holders/proponents' credentials.

Just as not all opinions are equally valid, some peoples' opinions are

worth more serious consideration than others because of such factors

as (when it comes of CM):

 

A. Number of years in practice

B. i) Type, duration, place of entry-level education, ii) type

duration, place of subsequent education, including the credibility of

the opinion-holders' teachers/trainers

C. Identifiable biases based on sex, age, ethnicity, education,

experience, politics, religion, philosophical position, etc., etc.,

etc. which might affect the credibility of the opinion

D. General credibility of the body of their work

E. Ability to access important source materials which might affect the

opinion in question, e.g. the ability to read Chinese (or other East

Asian language)

G. Individual intelligence and insight (or genius)

 

Unfortunately, this is not the kind of mature judgment-making taught

at most of our schools and colleges. Therefore, all too often, the

answer is either doctrinaire (It is what it is because I say so) or is

universally relative (Whatever; suit yourself; there is no right answer).

 

As an extension of this, this is why one needs to read the

" bibliographic " page at the front of books (when published, when

revised, etc.) as well as the bibliography at the end. Without taking

those things into account, one cannot really assess the materials

contained in a book or article. That's why scholarly books include

bibliographies. Otherwise, all opinions may seem to be equally valid.

 

 

 

 

 

_____

 

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3261 Newsletters for me

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[Guest guest]

I'll be out of town and off-line teaching in Baltimore this weekend. I

won't be back on line till Tuesday, Feb. 19. Have a nice weekend all.

 

Bob

[Guest guest]

Phil -

 

I think that there are 2 things to examine here.

 

1. When we say that a pulse is > or < 4 beats per

breath, whose breath are we talking about? Most

practitioners I speak to think that we are talking

about the patients breath - that there should be about

4 pulse beats per patient's breath. In fact, based on

my reading, that is not the case. The pulse rate is

compared to the practitioner's breath. The

practitioner's breath is the only one that he/she can

use as a standard and therefore the patient's pulse

should be approximately 4 times for each

inhalation/exhalation of the practitioner - otherwise

there is no standard across a patient's population.

So, the first thing is that the practitioner needs to

standardize his/her own breath and be aware of how

they are breathing when taking pulses.

 

2. We have a tool today that perhaps was not

available when things about beats/breath were written

- watches with second hands. These are, in the end,

much more precise and much more standard than

beats/breath. I, like most of us, was taught that

anything over 80 bpm was " fast. " While the " standard "

for rapid in biomedicine has risen to 90 BPM, I don't

think that the standard has changed in CM and anything

over 80 BPM is still fast. Finally, I would caution

practioners not to take a pulse rate for less than 30

seconds. I do this experiment with my students all

the time. Take a rate for 10 sec & multiply by 6, 15

seconds and multiply by 4, 20 seconds and multiply by

3, 30 seconds & multiply by 2 and 60 seconds. See if

you get the same rate each time. It is very easy, if

taking the rate for only 10 - 15 seconds to start

counting on an up beat and stop counting on an up beat

and then have that multiplied by 6, causing your rate

to appear much faster than it actually is.

 

Marnae

[Guest guest]

According to Bob Flaws and Maciocia, the number of breaths are correlated

with the practitioner. This puts it on the practitioner to be healthy enough

to have a normal breath pattern.

 

Bob Flaws, easily dismisses counting the breath pattern in favor of using a

timepiece to measure speed. He says above 90 BPM is rapid, while Maciocia

say 82, Graham Townsend on page 97 in his book Pulses and Impulses agrees

that above 90 BPM is rapid, John Shen says above 82 is fast. I've seen some

Western sources that say Presumably none of these are primary sources of

information so one wonders about the origin of it. The wonderful book

called " The Pulse In Occident and Orient by R.B. Amber describes and

compares pulse diagnosis Chinese, Western and Ayurvedic. and under the

Western pulse on page 137 he describes a rapid pulse beyond 90 BPM. Other

contemporary sources I've seen put it at 90 BPM.

 

Now the coup de gras question is if we use an objective measurement such as

a timepiece to measure the pulse -- this is normally the same in all

positions. So the factor of determining heat in a particular region or organ

is greatly compromised. No one ever addresses that issue. I know Bob Flaws

is away but he would be a good one to respond to this. However if one

measures the breaths of the patient compared to the breath of the

practitioner a certain degree of subjectivity is there which allows for a

possible perception of a pulse being faster in one position as opposed to

another.

John Shen says a pulse of 96 and above is really fast while other sources

put it at 120 BM and above (these would be tachycardia)

 

 

Finally I am copying this from a western source for reference:

http://hk-doctor.com/tool/html/Pulse_E.htm

 

NORMAL PULSE RATE

Average Beats per Minute

The Unborn Child 140 to 150

Newborn Infants 130 to 140

During first year 110 to 130

During second year 96 to 115

During third year 86 to 105

7th to 14 year 76 to 90

14th to 21st year 76 to 85

21st to 60th year 70 to 75

After 60th year 67 to 80

 

Notes:

Pulse rates rise normally during excitement, following

physical exertion and during digestion.

 

The pulse rate is generally more rapid in females.

The pulse rate is also influenced by the breathing rate.

(I know I've been able to consciously slow my pulse by consciously slowing

my breathing rate -- this fact seems to lessen its objectivity)

 

Variation of one degree of temperature above 98?F. is

approximately equivalent to a rise of 10 beats in pulse

rate :

 

Temp.98 F. corresponds with pulse of 60 per minute.

Temp.99 F. corresponds with pulse of 70 per minute.

Temp.100 F. corresponds with pulse of 80 per minute.

Temp.101 F. corresponds with pulse of 90 per minute.

temp.102 F. corresponds with pulse of 100 per minute.

Temp.103 F. corresponds with pulse of 110 per minute.

Temp.104 F. corresponds with pulse of 120 per minute.

 

 

_____

 

 

On Behalf Of marnae ergil

Friday, February 15, 2008 6:13 AM

 

Re: How fast is a fast pulse -- really?

 

 

 

Phil -

 

I think that there are 2 things to examine here.

 

1. When we say that a pulse is > or < 4 beats per

breath, whose breath are we talking about? Most

practitioners I speak to think that we are talking

about the patients breath - that there should be about

4 pulse beats per patient's breath. In fact, based on

my reading, that is not the case. The pulse rate is

compared to the practitioner's breath. The

practitioner's breath is the only one that he/she can

use as a standard and therefore the patient's pulse

should be approximately 4 times for each

inhalation/exhalation of the practitioner - otherwise

there is no standard across a patient's population.

So, the first thing is that the practitioner needs to

standardize his/her own breath and be aware of how

they are breathing when taking pulses.

 

2. We have a tool today that perhaps was not

available when things about beats/breath were written

- watches with second hands. These are, in the end,

much more precise and much more standard than

beats/breath. I, like most of us, was taught that

anything over 80 bpm was " fast. " While the " standard "

for rapid in biomedicine has risen to 90 BPM, I don't

think that the standard has changed in CM and anything

over 80 BPM is still fast. Finally, I would caution

practioners not to take a pulse rate for less than 30

seconds. I do this experiment with my students all

the time. Take a rate for 10 sec & multiply by 6, 15

seconds and multiply by 4, 20 seconds and multiply by

3, 30 seconds & multiply by 2 and 60 seconds. See if

you get the same rate each time. It is very easy, if

taking the rate for only 10 - 15 seconds to start

counting on an up beat and stop counting on an up beat

and then have that multiplied by 6, causing your rate

to appear much faster than it actually is.

 

Marnae

 

 

 

 

_____

 

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3266 Newsletters for me

You can use it too - and it's FREE! www.ellaforspam.com

 

 

 

[Guest guest]

Hi All, & Marnae,

 

Marnae wrote:

> Phil, I think that there are 2 things to examine here.

 

> 1. When we say that a pulse is > or < 4 beats per breath, whose breath

> are we talking about? Most practitioners I speak to think that we are

> talking about the patients breath - that there should be about 4 pulse

> beats per patient's breath. In fact, based on my reading, that is not

> the case. The pulse rate is compared to the practitioner's breath. The

> practitioner's breath is the only one that he/she can use as a standard

> and therefore the patient's pulse should be approximately 4 times for

> each inhalation/exhalation of the practitioner - otherwise there is no

> standard across a patient's population. So, the first thing is that the

> practitioner needs to standardize his/her own breath and be aware of

> how they are breathing when taking pulses.

 

I have problems to accept this. It makes two assumptions that do not

ring true for me as being a good " standard " , against which to measure

the patient's pulse:

 

(a) It assumes that the practitioner's respiration rate remains

constant, regardless of age, season, environmental temperature,

stress / hassle, presence of an attractive member of the opposite (or

same?) sex, practitioner's health status (first days of a fever,

etc), etc;

 

(b) It assumes that all practitioners have the same (or almost the

same) respiration rate.

 

Let us take patient X, with a REAL pulse rate (measured with an

accurate watch) of 84 BPM.

 

Let us assume that the SAME patient is examined in the resting state

at an interval of 2 minutes by two TCM practitioners.

 

Practitioner A has a current respiration rate of 15 breaths/min and

Practitioner B has a current respiration rate of 21 breaths/min.

 

Practitioner A would classify the patient as having a rapid pulse

because the pulse/breath ratio was 84/15, i.e. 5.6

 

Practitioner B would classify classify the patient as having a normal

pulse because the pulse/breath ratio was 84/21, i.e. 4.0

 

I cannot accept that as a good standard. For me, for reasons given

above, if one does not wish to use an accurate watch, the pulse /

breath ratio of the PATIENT is a better standard that the ratio of

the patient's pulse rate / therapist's breath rate.

 

> 2. We have a tool today that perhaps was not available when things

> about beats/breath were written - watches with second hands. These are,

> in the end, much more precise and much more standard than beats/breath.

 

I agree.

 

But is is NOT necessary to have watches with a second hand to measure

time repeatedly with good accuracy. For example, water-clocks and

sand clocks are pre-christian, and may go back to 1000-1500 BC.

 

If a practitioner WITHOUT a modern watch wanted to count breaths, or

pulses over a FIXED, REPEATABLE time, he/she could build a very

simple time standard by suspensing a balanced weight (a stone, or

piece of jade) from a string of fixed length (say 1 metre), and start

it swinging (from a fixed arc position from the centre) and count the

pulse or breaths for, say, 50 or 100 swings of the pendulum.

 

Of course the pendulum method would not allow one to say how many

breaths or pulse beats per minute, but it would allow ranking of

patients' pulse & breath rates standardised to a fixed number (50 or

of 100) swings.

 

> I, like most of us, was taught that anything over 80 bpm was " fast. "

> While the " standard " for rapid in biomedicine has risen to 90 BPM, I

> don't think that the standard has changed in CM and anything over 80 BPM

> is still fast.

 

I knew (as far back as second year in in vet school, 1960) that age,

physiological state, environment, exertion, stress, etc all can

influence pulse rate.

 

I had read in books on TCM / acupuncture that a pulse rate >80 BPM is

classed as fast in TCM.

 

Then I stumbled on Bob Flaws' article and began to trawl WWW to see

what standard others use. And this opened a can of worms; it is clear

that there is not universal agreement on that issue, even amongst

acknowledged experts in the field.

 

> Finally, I would caution practioners not to take a pulse rate for less

> than 30 seconds. I do this experiment with my students all the time.

> Take a rate for 10 sec & multiply by 6, 15 seconds and multiply by 4,

> 20 seconds and multiply by 3, 30 seconds & multiply by 2 and 60

> seconds. See if you get the same rate each time. It is very easy, if

> taking the rate for only 10 - 15 seconds to start counting on an up

> beat and stop counting on an up beat and then have that multiplied by

> 6, causing your rate to appear much faster than it actually is. Marnae

 

Agreed. That lesson was taught to us in vet school in the 1960s.

 

Best regards,

 

[Guest guest]

According to Bob Flaws and Maciocia, the number of breaths are correlated

with the practitioner. This puts it on the practitioner to be healthy enough

to have a normal breath pattern.

 

Bob Flaws, easily dismisses counting the breath pattern in favor of using a

timepiece to measure speed. He says above 90 BPM is rapid, while Maciocia

say 82, Graham Townsend on page 97 in his book Pulses and Impulses agrees

that above 90 BPM is rapid, John Shen says above 82 is fast. I've seen some

Western sources that say Presumably none of these are primary sources of

information so one wonders about the origin of it. The wonderful book called

" The Pulse In Occident and Orient by R.B. Amber describes and compares pulse

diagnosis Chinese, Western and Ayurvedic. and under the Western pulse on

page 137 he describes a rapid pulse beyond 90 BPM. Other contemporary

sources I've seen put it at 90 BPM.

 

Now the coup de gras question is if we use an objective measurement such as

a timepiece to measure the pulse -- this is normally the same in all

positions. So the factor of determining heat in a particular region or organ

is greatly compromised. No one ever addresses that issue. I know Bob Flaws

is away but he would be a good one to respond to this. However if one

measures the breaths of the patient compared to the breath of the

practitioner a certain degree of subjectivity is there which allows for a

possible perception of a pulse being faster in one position as opposed to

another.

John Shen says a pulse of 96 and above is really fast while other sources

put it at 120 BM and above (these would be tachycardia)

 

Finally I am copying this from a western source for reference:

http://hk-doctor.com/tool/html/Pulse_E.htm

<http://hk-doctor.com/tool/html/Pulse_E.htm>

 

NORMAL PULSE RATE

Average Beats per Minute

The Unborn Child 140 to 150

Newborn Infants 130 to 140

During first year 110 to 130

During second year 96 to 115

During third year 86 to 105

7th to 14 year 76 to 90

14th to 21st year 76 to 85

21st to 60th year 70 to 75

After 60th year 67 to 80

 

Notes:

Pulse rates rise normally during excitement, following physical exertion and

during digestion.

 

The pulse rate is generally more rapid in females.

The pulse rate is also influenced by the breathing rate.

(I know I've been able to consciously slow my pulse by consciously slowing

my breathing rate -- this fact seems to lessen its objectivity)

 

Variation of one degree of temperature above 98?F. is approximately

equivalent to a rise of 10 beats in pulse rate :

 

Temp.98 F. corresponds with pulse of 60 per minute.

Temp.99 F. corresponds with pulse of 70 per minute.

Temp.100 F. corresponds with pulse of 80 per minute.

Temp.101 F. corresponds with pulse of 90 per minute.

temp.102 F. corresponds with pulse of 100 per minute.

Temp.103 F. corresponds with pulse of 110 per minute.

Temp.104 F. corresponds with pulse of 120 per minute.

 

_____

 

 

<%40>

[

<%40> ] On Behalf Of marnae ergil

Friday, February 15, 2008 6:13 AM

 

<%40>

Re: How fast is a fast pulse -- really?

 

Phil -

 

I think that there are 2 things to examine here.

 

1. When we say that a pulse is > or < 4 beats per breath, whose breath are

we talking about? Most practitioners I speak to think that we are talking

about the patients breath - that there should be about

4 pulse beats per patient's breath. In fact, based on my reading, that is

not the case. The pulse rate is compared to the practitioner's breath. The

practitioner's breath is the only one that he/she can use as a standard and

therefore the patient's pulse should be approximately 4 times for each

inhalation/exhalation of the practitioner - otherwise there is no standard

across a patient's population.

So, the first thing is that the practitioner needs to standardize his/her

own breath and be aware of how they are breathing when taking pulses.

 

2. We have a tool today that perhaps was not available when things about

beats/breath were written

- watches with second hands. These are, in the end, much more precise and

much more standard than beats/breath. I, like most of us, was taught that

anything over 80 bpm was " fast. " While the " standard "

for rapid in biomedicine has risen to 90 BPM, I don't think that the

standard has changed in CM and anything over 80 BPM is still fast. Finally,

I would caution practioners not to take a pulse rate for less than 30

seconds. I do this experiment with my students all the time. Take a rate for

10 sec & multiply by 6, 15 seconds and multiply by 4, 20 seconds and

multiply by 3, 30 seconds & multiply by 2 and 60 seconds. See if you get the

same rate each time. It is very easy, if taking the rate for only 10 - 15

seconds to start counting on an up beat and stop counting on an up beat and

then have that multiplied by 6, causing your rate to appear much faster than

it actually is.

 

Marnae

 

_____

 

<< ella for Spam Control >> has removed 5330 Spam messages and set aside

3266 Newsletters for me

You can use it too - and it's FREE! www.ellaforspam.com