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Book: Secret of Pulse Diagnosis

AUTHOR COMMENTS: For the first 10 years of my practice, I was never really confident with my pulse diagnosis. Then one day I realized that, because I had never really memorized the exact, word for word definitions of the 28 pulses, I was feeling certain pulses all the time in my clinical practice but failing to label them correctly. Therefore, I immediately sat down with a variety of Chinese texts and began clarifying and then memorizing the definitions of each of the 28 pulses. This one act alone revolutionized my practice. Now practitioners all over the U.S. refer patients to me just to have me read their pulses. While this is flattering, it is also a shame. Chinese pulse examination is not all that difficult if you know the secret, and the secret is not some special tactile skill. It is essentially an issue of words. Although some students persist in thinking that good pulse examination skills have something to do with esoteric and arcane lore or superhuman tactile sensitivity, I know this method works because scores of students to whom I have taught tell me that it has revolutionized their pulse-taking abilities as well.

BACKCOVER: For more than 2,000 years, Chinese doctors have relied on pulse diagnosis to identify patterns of disharmony in the body. The ability to read the pulse remains a crucial diagnostic tool in Chinese medicine to this day. Unfortunately, few Western practitioners of Oriental medicine feel truly competent in this art.

In this book, Bob Flaws, a world-renowned Western teacher and practitioner of Traditional Chinese Medicine, explains why Western students and practitioners often have difficulty reading the pulse. He then reveals the secret of mastering the subtle art of Chinese pulse diagnosis, offering a way for anyone who applies this method in clinical practice to feel all 27 or 28 classical pulses.

AUTHBIO: Author, translator, or editor of more than 100 books on acupuncture and Chinese medicine, Bob Flaws has earned a reputation as a clear, insightful, and organized teacher. In addition to being an NCCAOM diplomat of acupuncture and Chinese herbal medicine, Bob is also a Fellow and past Governor of the National Academy of Acupuncture & Oriental Medicine, a founder, past President, and Lifetime Fellow of the Acupuncture Association of Colorado, a Fellow of the Register of Chinese Herbal Medicine (UK), and a founder of the Council of Oriental Medical Publishers. Bob has been in private practice in Boulder, CO since 1977.

TABLE OF CONTENTS:
Preface to the First Edition
Preface to the Second Edition
1 Introduction
2 The Divisions of the Pulse at the Inch Opening & Their Correspondences
3 Feeling the Pulse images
4 The Technique of Examining the Pulse
5 Interpreting the Pulse
6 The Indications of the Main Pulse Images
7 Pattern Discrimination & The Pulse Images
8 Pulse Images & The Three Positions
9 The Pulse in Gynecology
10 Traditional Pulse Lore Contained in Mnemonic Verse
11 The Rhymed Formula of the Heart Methods of the Pulse
12 Unusual Pulse Images
13 Reading the Cubit Positions
14 Yin Fire & The Pulse
Bibliography
Index

EXCERPT: The Importance of Pulse Examination

As seen above, pulse examination is one of the main methods of establishing a tcm pattern discrimination. Pulse examination in modern tcm primarily means the feeling of the pulse of the radial arteries at the styloid processes of both wrists. This is commonly called the cun kou or inch opening. It is believed by practitioners of Chinese medicine that the pulses felt here can be read as a simulacrum of the flow of qi, blood, and body fluids of the entire body. The first chapter of the Nan Jing (Classic of Difficulties) opens with the following question:

All the twelve channels have [sections where the] movement [in these] vessels [can be felt]. Still, one selects only the cun kou in order to determine whether the five viscera and six bowels [harbor a] pattern of death or life, of good or evil auspices. What does that mean?

The answer of why one can determine the health and disease of the entire body by feeling the pulses at the cun kou on the wrists that the Nan Jing gives is this:

The cun kou constitutes the great meeting point of the [contents passing through] the vessels. It is the [section of] the hand tai yin [channel where the] movement [in that] vessel [can be felt]. When a [normal] person exhales once, [the contents of] the vessels proceed 3 inches. When [a normal person] inhales once, [the contents of] the vessels proceed [another] 3 inches. Exhaling and inhaling [constitute one] breathing [period]. During this period, [the contents of] the vessels proceed 6 inches. A person, in the course of one day and one night, breathes altogether 13,500 times. [During that time, the contents of] the vessels proceed through 50 passages. [That is,] they circulate through the body [in the period needed by] the [clepsydra's] dripping water to move down by 100 markings. The constructive and defensive [qi] proceed through 25 passages [during a] yang [period], and they proceed through 25 passages [during a] yin [period]. This constitutes one cycle. Because [the contents of the vessels] meet again, after 50 passages, with the cun kou, [this section] is the beginning and the end of [movement of the contents of the vessels through the body's] five viscera and six bowels. Hence, the pattern [of death or life, good or evil auspices harbored by the body's five viscera and six bowels] may be obtained from the cun kou.

Whether or how one chooses to accept this explanation aside, it is a fact that practitioners of Chinese medicine have been diagnosing and treating patients on the basis of pulse examination carried out at the inch opening for at least 2000 years. On the other hand, most Western students of tcm find pulse examination very confusing and difficult to master. It seems somehow very mystical and arcane. Although most Western practitioners express a strong belief and interest in pulse examination, few, I think, feel very confident of their abilities in this domain.

This Western ambivalence toward and pervasive lack of mastery of pulse examination is, I believe, exacerbated by a somewhat similar attitude toward pulse examination current in the Peoples' Republic of China at least in the 1980s. When I was a student in China during that time, the importance of pulse examination was deliberately played down by many of my teachers and clinical preceptors. Based on conversations, it seems they felt that pulse examination was hard to validate by Western anatomy and physiology and, therefore, was a bit of an embarrassment to people who were desperately trying to become modern and scientific. At that time, I never had a teacher tell me a pulse was anything other than bowstring, slippery, fast, slow, floating, deep, or fine. One of my teachers only took the pulse with two fingers and never expressed her readings in terms of the three basic positions of the pulse. When queried about this, she said that it is scientifically impossible for the pulse to have different qualities or images in different positions. Ergo, one does not have to worry about positions.

What I mean to say is that, although pulse examination comprises at least one third of the diagnostic criteria for making a tcm pattern discrimination, many modern Chinese teachers and the majority of the modern Chinese tcm literature of which I am aware, tend not to be very sophisticated in their explanation and use of pulse examination. Rather, it seems that many modern Chinese tcm practitioners relegate pulse examination to a minor, confirmatory role. While Western practitioners believe that pulse examination is mystical, and therefore difficult to learn, many modern Chinese practitioners believe it is mystical, and therefore not worth learning.

However, this is not my experience. I believe that mastery of pulse examination is vitally important for making a correct tcm pattern discrimination. And I believe that pulse examination is, perhaps, even more important for Western practitioners than for our Chinese counterparts. This is because it is my experience that our patients are sick in more complex ways than many Chinese patients. In China, most young practitioners do not go into private practice working in isolation from senior practitioners with lifetimes of experience. It is my experience that young practitioners in China are given relatively simple cases to treat, and, should they come across a complicated, difficult case, they can always ask a senior practitioner to help parse out the pattern discrimination. Western practitioners, on the other hand, tendD to go immediately into private practice, and that after insufficient clinical education as an undergraduate. Typically, there is no one else in the clinic to ask about a difficult case. In addition, we as Western practitioners tend to see a disproportionate number of difficult cases which are either not self-limiting or have not been successfully treated by modern Western medicine and often other types of alternative medicine as well. This is because, here in the West, we are so often practitioners of last resort. Further, because of the modern Western diet, the adverse effects of certain modern Western medical treatments, the ill effects of pollution, and the pervasive stress of our modern society, most of our patients suffer from complex, chronic conditions which frequently and I might even say typically do not display the nice, neat, simple patterns contained in beginners' tcm textbooks.

In my experience, all too often, our patients present, not with one textbook pattern or another, but with a combination of three, four, or even five patterns. When the disease mechanisms at work in such complex patterns interact with each other, they produce complicated mixtures of signs and symptoms, including complicated and sometimes even seemingly contrary pulse images. Thus it is also my experience that if one wants to parse out such complicated patterns, one must be able to feel more than just the several pulse images enumerated above. In addition, one must also understand how each pulse is created and the secondary and tertiary meanings of all of the pulse images. In other words, it is my experience that a simplistic approach to pulse examination is not sufficient for the practice of tcm in the West.

PAGES: 160