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Pulse diagnosis in Chinese medicine - Chinese Medicine Update

Townsend Letter for Doctors and Patients, Dec, 2003 by Bob Flaws

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For instance, a pulse may be slippery and bowstring. It may be slippery, bowstring, and deep or slippery, bowstring, and floating. It may be soggy and rapid or soggy and bowstring. It may be choppy, bowstring, and deep. A not uncommon multifaceted pattern of pulse found in perimenopausal North American females is to have a normal or slightly rapid pulse rate overall with a floating, fine pulse in the left inch, a bowstring, fine pulse in the left bar, and floating, fine pulse in the left cubit. In the right inch, the pulse is surging (meaning floating, large, and forceful), is floating, bowstring, and forceful in the right bar, and deep and bowstring in the right cubit. By itself, this suggests that there is liver blood-kidney yin and yang vacuity with vacuity heat floating upward, liver depression, and spleen with an exuberant stomach vacuity. Whether this is true or not depends on the patient's other signs and symptoms. If this were truly the case, then we would expect there to also be night sweats and/or hot flashes, fatigue, irritability, possible depression, cold feet, nocturia, low back pain, and possible low libido but a strong appetite. If a preponderance of these other signs and symptoms do not present, then we are probably wrong in our interpretation.

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As stated above, correct interpretation of the pulse also depends on the depth and breadth of one's knowledge and understanding of Chinese medical theory. The more Chinese medicine one knows, the easier the interpretation of the pulse becomes. For instance, if one well understands the Chinese medical spleen's role of upbearing the clear and one feels that the pulse is absent in the right inch, extremely fine and forceless in the left inch, and bowstring, fine, and forceless in the right bar, then it is relatively easy to hypothesize that there is a chest qi vacuity due to a spleen qi vacuity associated with liver depression. In that case, one should also know the questions to ask and tongue to look for to corroborate this hypothesis. If one does not know or understand this particular Chinese medical theory, then it is less likely they would come easily or quickly to this interpretation. Thus, although learning how to feel the 28 pulse images can be accomplished in days, it typically takes years to learn how to correctly and reliably interpret what one feels.

Patterns vs. Diseases & the Importance of Pulse Examination

In modern Western (and, therefore, modern Chinese) medicine, diseases can be asymptomatic. For instance, a patient may have herpes genitalia or herpes zoster and be in remission. Thus they present no signs or symptoms of herpes. However, in Chinese medicine, it is axiomatic that patterns are presentations of standard collections of signs, symptoms, tongue and pulse signs. Therefore, there are no asymptomatic patterns. Patterns are nothing other than patterns of signs and symptoms. If patterns are defined by the three elements of signs and symptoms, tongue signs, and pulse signs, then pulse examination is an extremely important part of Chinese medical pattern discrimination. While pulse examination has been relegated in the last 300 years to mostly confirmatory status, it is still an important, indispensable diagnostic modality within Chinese medicine. In antiquity and even to this day, some Chinese doctors believe that they can diagnose asymptomatic disease via the pulse. Why bother? We have many other, more reliable and objective methods of examination, such as serum analysis, X-rays, CT scans, and MRIs. But, when it comes to Chinese medical pattern discrimination, pulse examination is still a crucial part, and it should be remembered that, in Chinese medicine, treatment is primarily predicated on the patient's pattern.

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Pulse diagnosis in Chinese medicine - Chinese Medicine Update

Townsend Letter for Doctors and Patients, Dec, 2003 by Bob Flaws

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