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Pulse diagnosis in Chinese medicine - Chinese Medicine Update | | Townsend Letter for Doctors and Patients, Dec, 2003 by Bob Flaws | | | Keywords: Chinese medicine, Chinese pulse examination, pattern discrimination | | [ILLUSTRATION OMITTED] | | Professional Chinese medicine bases its treatment on two diagnoses (liang zhen). There is the disease diagnosis (bian bing) and the pattern discrimination (bian zheng). Today, the disease diagnosis is also divided into two types. There is the modern Western medical diseases diagnosis, such as poliomyelitis and rheumatoid arthritis, and the traditional Chinese disease diagnosis of wilting condition (wei zheng) and impediment condition (bi zheng) respectively. Although, these days, treatment is predicated to some degree on all three of these diagnoses, treatment is mainly based on the patient's personal pattern discrimination. Thus it is said, Yi bing, tong zhi; Tong bing, yi zhi--Different diseases, same treatment; Same disease, different treatments. | | For example, one patient may present with systemic lupus erthymatosus (SLE), while another patient may present with rheumatoid arthritis (RA). In Western medicine these are two different diseases. However, in Chinese medicine, if both patients present with a pattern of wind damp heat impediment, then they will receive identical treatments regardless of the fact that they suffer from different diseases. Conversely, two patients may both present with rheumatoid arthritis. However, if one of these presents a pattern of wind damp cold impediment and the other presents a pattern of wind damp heat, these two patients will receive markedly different treatments. Although some of the Chinese herbal medicinals they receive may be the same, others included for one patient may actually worsen the condition of the other. | | Therefore, pattern discrimination is extremely important in standard professional Chinese medicine. There are more than 300 professionally agreed upon, standard patterns in Chinese medicine, and real-life patients often manifest multi-pattern presentations. For instance, patients with chronic diseases rarely present less than three patterns simultaneously and sometimes up to 10. At the moment, the criteria for establishing the presence of a Chinese medical pattern are the so-called four examinations (si zhen). These are visual inspection, auscultation-olfaction, questioning, and palpation. Visual inspection means inspection of the facial complexion, the bodily constitution, carriage and gait, any diseased or painful areas, and especially the tongue. (I will talk about Chinese tongue examination in next month's column.) Palpation means manual palpation of any diseased areas or regions of pain but mainly refers to palpation of the pulse on the radial side of both wrists. These four streams of information are then analyzed into three groups of information: 1) general signs and symptoms, 2) tongue signs, and 3) pulse signs. This means that pulse examination (mai zhen) is one third of the criteria used to establish the presence of a particular pattern in contemporary standard professional Chinese medicine. | | The Inch Mouth | | There are many pulses in the body, but the place where Chinese doctors take the pulse is called the "inch mouth" (cun kou). This refers to the radial artery at the styloid processes of the wrists. Chinese doctors have been feeling the pulses diagnostically at this location for at least 2,000 years. It is believed that pathological changes in the entire body are reflected in changes in the pulses at this position. In practice, this pulse is first divided into three sections (san bu), the inch, bar, and cubit. The practitioner begins by resting their middle finger directly over the patient's styloid process. This is called the guan or bar position because it separates the other two positions. Then the practitioner's index finger falls into the space between the styloid process and the hypothenar eminence. This is called the cun or inch position because it is one inch wide. The practitioner's ring finger then falls just proximal to their middle finger. This position is called the chi or cubit position because there is one cubit in length between this position and the crook of the elbow. | | The Three Positions Correspondences with the Rest of the Body | | Since at least the late Han dynasty, 200 AD or CE, Chinese doctors have believed that the changes in the pulse at the inch position reflect changes in the area of the body from the diaphragm to the top of the head, including the two arms. This area is called the upper burner (shang jiao). Changes in the bar position correspond to changes in the area of the body from the diaphragm to the level of the navel. This area is called the middle burner (zhong jiao). Changes in the cubit position correspond to changes in the area of the body from the level of the navel to the soles of the feet. This area is called the lower burner (xia jiao). Since the late Ming dynasty (circa 1575), most Chinese medical practitioners believe they can "read" the heart in the left inch, the lungs in the right inch, the liver-gallbladder in the left bar, the spleen-stomach in the right bar, and the kidneys, bladder, and large and small intestines in the two cubits. Therefore, a pathological change in the pulse of the right inch may reflect a lung disorder or a problem with the right arm or right side of the head. This depends on the corroboration of the patient's main complaint and other signs and symptoms. One of the first rules of Chinese medical diagnosis is that no one sign or symptom means anything by itself. It is only meaningful when compared with other signs and symptoms. | | The Normal Pulse | | In Chinese medicine, the normal healthy adult pulse comes at 60-90 beats per minute. It has a slippery, flowing quality, can be felt in all three positions on both sides, and does not skip any beats. It is neither too superficial nor too deep, to thin or too wide, nor is it hard or tense. This is called the ping mai, level or normal pulse. Such a normal pulse suggests that yin and yang within the body are in balance, the five viscera and six bowels are working in a healthy, coordinated fashion, and there are no evil qi present, whether externally contracted or internally engendered. | | The Constitutional Pulse | | In old China, when Chinese medicine was mostly village medicine, the family doctor would take the constitutional pulse of the patient when they were healthy so that they would have a baseline to compare to when the patient was ill. This constitutional pulse was taken in the early morning just before daylight and before the patient had eaten or drunk, moved about, or had sex. This is similar to taking the basal body temperature (BBT) to assess the basal metabolic rate. However, as far as I know, this is no longer done. Today, patients come to the doctor when they are sick. Therefore, the main emphasis in learning how to examine the pulse is on the diseased pulse or bing mai. | | The 28 Pulse Images | | Chinese doctors learn that there are 28 diseased pulse images. These are 28 ways the pulse reflects pathological changes in the body correlated with Chinese medical pattern discrimination. These 28 pulse images are taught, like so much of Chinese medicine, using a yin-yang dichotomy. Thus we have the floating and deep pulses, the large and small pulses, the fast and slow pulses, the slippery and choppy pulses, the short and long pulses, etc. According to Hua Tuo, a late Han dynasty expert in Chinese medical diagnosis, the majority of these 28 pulse images can be grouped under four headings. These four headings are: floating, deep, fast, and slow. For instance, there are seven floating or superficial pulses: floating, vacuous, drumskin, scallion-stalk, scattered, soggy, and surging; and four deep pulses: deep, hidden, confined, and weak. Similarly, there are five slow pulses: slow, bound, regularly intermittent, choppy, and moderate (meaning slightly slow); and there are four rapid pulses: rapid, skipping, racing, and stirring. The skipping, bound, and regularly intermittent pulses all skip beats. The skipping pulse is rapid and skips beats irregularly, while the bound and regularly intermittent pulses are both slow. The bound pulse is slow and skips beats irregularly, and the regular intermittent pulse is slow and skips beats at regular intervals with frequently alarmingly long pauses between beats. |
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