TCM: Irregularly Irregular
I like to take a pulse for a good few minutes while I chat with my patient.
This allows me to:
1. Feel for the overall pulse image
2. Check the pulse at various depths and lengths
3. Compare rear-to-rear, middle-to-middle, and front-to-front positions
In this time, if the pulse is irregular, I am sure to feel it. There are two types of irregular pulses that I am concerned with:
1. Regularly Irregular
2. Irregularly Irregular
The most common I have found in the clinic is the second one - Irregularly Irregular - as this is when a patient's pulse skips beats at random, possibly indicating an electrical problem. If I had to pick which one I want to discover, it would be the second one. After discovering any irregular pulse, I calmly ask my patient if they are aware that they have an irregular heartbeat. If they say yes then I chart that they are aware. If they aren't aware, I highly recommend they see their MD/GP and chart that I have made this suggestion. I will also follow up with them on the next visit to find out if their MD has found what I had and what their next course of action is.
Most often, with Irregularly Irregular pulses, the MD is not concerned; however, sometimes the doctor sends my patient for more testing regarding their arrhythmia. More testing often indicates atrial fibrillation which the MD may want to try to regulate with medication.
Regularly Irregular pulse indicate a missed beat at a regular interval. This generally indicates a physical problem such valve disorders. This can be a serious condition and follow-up questions such as if the patient has shortness of breath, chest pain, and/or swelling should be asked. Regardless, the patient should be seen by their MD if they aren't aware that they have this irregular heartbeat.
Within the realm of Traditional Chinese Medicine, irregular heartbeats are treated as signs that are part of a larger picture:
- Any type of sharp, stabbing pain indicates Blood Stasis (PC4, SP10, UB17, UB14, UB15)
- Heart palpitations are often a sign of Heart Qi/Blood Deficiency (HT7, PC6, UB15)
- Any pulse disorder treatment can be augmented with an Influential of Vessel (LU9), and Influential of Blood (UB17)
- Shortness of breath is often Lung Qi or Heart Qi Deficiency (REN17, LU9, LU7 + KD6, HT7, UB13, UB15)
- Swelling is treated as Dampness (SP6, ST36, SP9, ST40, REN5, REN9, UB20, UB21)