Introduction

Pulse diagnosis in Chinese medicine is rich with complexity, uncertainty, and the unknown. Acknowledgement and respect for this mystery can be a powerful place from which to operate while attempting to identify, correlate and act upon the observations.

Pulse diagnosis is an important means of collecting information about the patient. It involves the practice of using the radial arterial pulse at the juncture of the wrist and forearm to make assessments. Contemporary practitioners typically place three fingers on the radial artery just proximal to the hands. The fingers are used to palpate each location which is considered to represent the anatomy in terms of systems, regions, organs, tissues, or channels. Qualitative distinctions such as hard to yielding, fast to slow, forceful and weak are used to determine the processes that are occurring at a given location of the radial pulse which correlates with the anatomy.

Pulse diagnosis, as a form of clinical inquiry, has received a great deal of attention over the millennia. The further current resurgence of interest in the clinical art of pulse diagnosis is present in a number of schools of thought from the Japanese traditions to the Menghe-Ding family to the students of this treatise in a Neoclassical frame.

The intended transformation of the discourse will range from small details of pulse images to the structural organization of the dialogue. I will explain. At the level of detail, there are incorrect or confusing information. These include discourse about the jin mai (tight pulse) and the se mai (choppy pulse). At the level of the dialogue, there is a need for attention to the thinking that goes into the selection of a given pulse method for the purposes of analysis. 

Historical Practices of Pulse Diagnosis

The subject matter of medicine includes the study of the organization, function and substance of the human body. As background, it is necessary to discuss some of the historical influences upon the development of pulse diagnosis in the east and the west prior to the discussion of the specific findings and subsequent interpretations.

Praxagorus presents one of the earliest records of pulse diagnosis in the West circa 340 B.C.E. as part of the first medical school of antiquity at Alexandria. His student Herophilus counted the pulse using the water clock and made subtle analyses regarding rhythm and rate. Using musical models, he built a rhythmical pulse lexicon that remained until recent times. The influence on pulse diagnosis from this group remained for 15 centuries until Harvey demonstrated the circulation of the blood in1628.(Harvey, 1628; Osler, 1913a)

The medieval Persian physician Avicenna states in the opening passage of his epic Canon, “Medicine is the science whereby the dispositions of the human body are known so that whatever is unnecessary is removed or healed by it, in order that health should be preserved or, if absent, recovered.” Toward this remarkable endeavor, pulse diagnosis has provided a primary means of knowledge regarding the inner workings of the human being since the burgeoning core of civilizations both east and west.(Siraisi, 1990)

The development of pulse diagnosis in western culture achieved first measurable validity in 1620 when Sanctorius designed a pulse rate-measuring instrument based on Galileo's pendulum clock called the pulsilogium. Later in 1710, Floyer published The Physician's Pulse Watch inspired by both Galen and Sanctorius. In his book Floyer included references to his predecessors. But he also added a great quantity of his own observations, comments and charts relating to the pulse, and he tried to establish relations between pulse rates and several other measurements, ‘I have many years try’d pulses by Minute in Common Watches, and Pendulum Clocks, when I was among my Patients; after some time I met with the common Sea-Minute-Glass, which I used for my cold bathing, and by that I made the most of my experiments.’

To obtain an exact measurement of the speed of the pulse, rather than to describe it as ‘weak’, ‘fast’, or ‘galloping,’ Floyer used a handheld watches made by a clock-maker Samuel Watson (fl. c.1687-1710), who adapted the watch for Floyer’s medical purposes. Watson was patronised by Sir Isaac Newton, and also was appointed Mathematician in Ordinary to King Charles II. One of his astronomical clocks can be seen now in the Library of Windsor Castle. Watson constructed for Floyer the first known stopwatch, and the first watch with a second hand. Floyer wrote: ‘I caused a Pulse-Watch to be made which runs 60 seconds, and I placed it in a Box to be more easily carried, and by this I now feel pulses.’(Floyer, 1707) Floyer became the first physician to time the pulse accurately, which is now a universal and routine medical practice.

The first Chinese texts where pulse diagnosis findings are similarly recorded is in the Han dynasty texts the Yellow Emperor’s Classic,(Wu NL, 1996) The Difficult Classic(P. t. Unschuld, 200 CE) and later, the Pulse Classic.(S. Wang, 1997b) Sir William Osler of John’s Hopkins University, during his 1913 lecture at Yale on “The Evolution of Modern Medicine,” considered the Chinese doctrine of the pulse to have reached such extraordinary development that the whole practice of the art centered around its different characters. The Chinese during the beginnings of the common area reached articulate definition, according to Osler “The basic idea seems to have been that each part and organ had its own proper pulse, and just as in a stringed instrument each chord has its own tone, so in the human body, if the pulses were in harmony, it meant health; if there was discord, it meant disease.”(Osler, 1913b) 

Xu Dachun (1693-1771) produced a chapter on the Mai Jing in his book Yixue Yuanliu Lun,(P. Unschuld, 1990) commenting that: Those experts who discussed the pulse through the ages have all contradicted one another, and they all differed in what they considered right and wrong. They all cling to their specific doctrine, and their advantages and errors balance each other. Students reading the Mai Jing must consult the Nei Jing, the Nan Jing, and the doctrines of Zhang Zhongjing [Huangdi Neijing, Jingui Yaolue]. Authors of antiquity often make admonitions such as "If those who practice medicine do not carry out pulse diagnosis with utmost care, they will not be able to save lives even with the greatest skills of their three fingers. Unfortunately, today's physicians know nothing about the pulses and do not take care when they write a prescription. No one knows how many patients they have killed with their therapies."(P. Unschuld, 1990)

The emergence of scientific discipline in modern China proposed a movement towards logical and internally consistent sets of dialogue that provide a more homogeneous face to the practice of Oriental Medicine, which exists in stark contrast to the disparate and often paradoxical considerations of the classical and folk traditions of Chinese medicine. An example of the direct impact on Chinese medical policy is found in the deletion of in-depth and detailed pulse diagnosis due to poor outcomes from inter-rater reliability studies on pulse diagnosis during the 1950s. It is possible that the failures of the 1950s Chinese pulse diagnostic studies were due to methodological and paradigmatic biases since there is an emerging body of evidence for the reliability of pulse diagnosis including recent studies that establish inter-rater reliability notably King et al 2002.(Chen DN, 2001; CY, 1990; Hwu YJ, 2000; C. D. King E, Ryan D, Walsh S, Ryan D, 2002a; C. D. King E, Ryan D., 2002b; Yoon SH, 1987)

There is modern literature that demonstrates the use of alternate pulse position methods. Tietao Deng identifies the four methods of ‘lifting, seeking, pressing and pushing.' These methods of seeking and pushing imply the process of rolling the fingers to get additional information. For instance, pushing across the surface of the vessel in order to feel the hardened vessel best identifies atherosclerotic vessels. Diagnostics of Traditional Chinese Medicine refers to a technique called sliding, stating, "In addition, another method, the sliding, is used. It is to move fingers around the pulse position to detect abnormal changes of pulse. By sliding along the vessel we can know whether the vessel is long or short, while moving fingers transversely, we can find if the pulse is oblique-running or ectopic radial."2 Neither of these texts however, provides interpretive criteria nor discusses the therapeutic implications of the pulse findings.