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THE SIGNIFICANCE OF TRADITIONAL PULSE DIAGNOSIS IN THE MODERN PRACTICE OF CHINESE MEDICINE
Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon
INTRODUCTION
The changing setting in which Chinese medicine is practiced in modern versus ancient times, especially with the advent of advanced technological medical diagnostics, has raised questions as to the value of pulse diagnosis. Should its use be limited to confirming a diagnosis reached by other means? Or, does the pulse information add critical information that can greatly alter the treatment strategy? Training in pulse diagnosis is often quite limited; further, the requisites for carrying out a traditional style diagnosis are sometimes absent from the clinical setting, making the results of the pulse taking less certain. How does one get the desired information under such circumstances?
THE POTENTIAL ROLE OF PULSE DIAGNOSIS IN MODERN PRACTICE OF TCM
In modern medicine, the traditional style of pulse diagnosis, which was also practiced in a slightly different form in Western medicine until the 19th century, is replaced by a number of other tests. Tests by stethoscope and blood pressure cuff are routinely performed as pulse diagnostic techniques. The stethoscope reveals pulse rate and, at a low level of inference, irregularities in the structure and function of the heart, which must be evaluated further. When deemed necessary, additional testing is performed via various heart monitors, such as an electrocardiogram. The non-invasive sonograms as well as the more invasive testing (e.g., insertion of monitors into the body) allow modern physicians to examine the interior of the arteries and the heart. The information from these tests is generally understood to reflect only the conditions of the heart and major vessels (the cardiovascular system); it is not thought of as a means of examining other aspects of health. Unlike the traditional concept, the pulse form or information obtained by examining the vessels is not thought to provide useful information about, for example, the liver, kidney, lung, or spleen conditions.
Modern medicine has numerous other kinds of tests, including blood tests, urine tests, and a variety of scans and biopsies, that reveal a tremendous amount of information about what goes on inside the body, so as to produce a diagnosis. Such tests reveal much about the functions of the internal organs; for example, inflammation of the liver or malfunction of the kidney filtration system is readily detected with a simple blood test. Most of these testing methods have been utilized only in recent decades and add a new dimension to the practice of Chinese medicine.
CONCLUSION
Pulse diagnosis is one method of determining the internal conditions of patients with the aim of deciding upon a therapeutic regimen. In order to make use of this diagnostic, the practitioner must learn the proper method of taking the pulse, the factors that influence the pulse, and the categories into which each patient's unique pulse form can be fit. Practitioners must remain especially alert to new factors that influence the pulse readings so as to assure that the results of pulse taking are meaningful. Most authorities agree that in the modern era one must be able to detect a relatively limited basic group of pulse forms in order to utilize the information for devising a therapy (i.e., acupuncture, herbs). These requisite forms determine whether the focus of the pathological process is at the body's surface or interior, is of a hot or cold nature, or is of an excess or deficiency type. The fundamental pulse categories that practitioners are to learn correlate directly with the well-known "eight methods of therapy" (see: Enumerating the methods of therapy). There have been recent attempts to broaden the scope of pulse diagnosis; for example, feeling the pulses immediately after insertion of acupuncture needles has been suggested recently as a means of determining whether the "qi has arrived" as a result of correct point selection and needle manipulation. There have also been attempts to more clearly define the pulse forms; for example, by developing medical equipment that can detect and record the pulse forms, and to develop statistical analysis of pulse types by disease. Pulse diagnosis remains an important part of the practice of traditional Chinese medicine that is still being explored and developed.