💓 The Deviated Pulse

Have you ever felt a deviated pulse?

This is an anatomical variation in the pulse where the artery is not in the usual position. Instead of going to LU-9, the artery goes along the other side of the styloid process closer to LI-5.

What does this mean, and can we use it diagnostically?

The Deviated Pulse

Normal Variations

When we go to take the pulse, there are certain "normal variations" we should be aware of. Some of these are:

• Age: Young children have a rapid pulse. Newborns can be up to 140 bpm. In eight-year-olds, 90 bpm is still considered normal. ​
• Sex: Women's pulses are typically weaker and thinner than men's (probably due to periodic blood loss). ​
• Season: Changes in the season are reflected in the body. In spring, the pulse is wiry. In summer, the pulse is surging. In autumn, the pulse is floating. In winter, the pulse is deep.

In addition to these, there is another type of variation that Bob Flaws calls anatomical variations. This is fan guan mai or the "deviated pulse".

Fan Guan Mai - The Deviated Pulse

Fan Guan Mai literally means, "opposite bar pulse." This is often translated as deviated pulse or sometimes ectopic radial.

(The guan or "bar" position is the middle position, in line with the styloid process.)

Rather than being felt in the normal position (with the radial artery going towards LU-9), this pulse is felt on the back of the wrist. The artery veers around the other side of the styloid process and goes towards LI-5.

If someone has a deviated pulse, it's usually only on one side and not the other.

(I have a deviated pulse on the right side only. One of my teachers in school had it on the left side only.)

What does the Deviated Pulse mean?

For the most part, nothing.

This is just an anatomical variation. For example, when you're locating the point PC-7, you may find that some people have only one tendon instead of two (the palmaris longus tendon is missing). This doesn't mean anything; it's just a genetic variation that some people have.

The authors of Fundamentals of Chinese Medicine write: "These irregularities have no significance in pattern identification."

In the Bin Hu Mai Xue, Li Shi-Zhen writes:

(If) inch opening, no pulse, (Then) investigate the outer wrist. This is called opposite bar (fan guan mai). This is not sufficient for blame.

So when he says, "This is not sufficient for blame," that means this pulse should not be taken as a pathological condition.

Can we diagnose with a Deviated Pulse?

Not really.

William Morris says, "Only the most general considerations may be evaluated when the pulse is on the back of the wrist, such as rate, force, and width."

Bob Flaws says, "Most commonly, these anatomical variations are found on only one wrist. In that case, one only examines the normal wrist."

At least in my case, the artery is directly on top of the bone, so there's no sense of "depth" to the pulse; it's just always superficial because there is no room for it to be deep.

I also think that, because of this variation, there's no way to distinguish between cun, guan, and chi. You'll have to use other diagnostic methods.

Clinical Application

The importance of this, I think, is just what Li Shi-Zhen said above: if you're trying to take the pulse in the normal position and you don't feel anything, check for a deviated pulse.

If you have trouble finding the pulse one side, that doesn't necessarily mean your patient is dying, or that they have some sort of block, or that you're bad at pulse. They may just have this anatomical variation.

So in that situation, move your fingers to the other side of the styloid process (along the Large Intestine channel), and see if you can feel a pulse there.

If you feel a deviated pulse, that doesn't mean anything significant. It just means that you'll have to rely on other diagnostic methods.

Have you ever felt a deviated pulse in clinic?

Have you every felt this pulse in clinic? Let me know!