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Seasonal Factors in Pulse Diagnosis

The Spiritual Axis describes a pulse for each season. The plant cycle provides an image whereby we can connect the pulse image to that of seasonal cycles and the concourse of nature. In spring plants sprout forth the similar status in the pulse takes place in the form of tension. When summer arrives, the plants are in full bloom and the pulse expands with a larger and urgent shape. As fall arrives, the vital forces begin to retreat and the pulse, while still reaching the surface, becomes uneven and uncertain as retreat begins. When winter arrives, the pulse becomes deep (see Table 6). These seasonal influences correspond to changes of life and experiences that occur between birth and death.

If the pulse does not match the season, there is a possibility of seasonal affective disorder, seasonal allergies or other conditions that arise in the context of seasonal disturbances. The seasonal affective disorders are often seen in the autumnal period as the light wanes. The herbal strategies tied to each pulse are as follows:

Season Pulse Condition Herbal Strategy
Summer Urgent Heat Cooling
Fall Floating Dryness Moistening, diaphoretic, supplementing
Winter Deep Damp Diuretic, warming
Spring Tense Stagnation Carminatives, diaphoretics

Pay attention to whether the pulse anticipates a following season, or correlates with a previous system. This can provide a sense of whether the person is forward focusing and anxious or backwards focused and depressed.

The urgent pulse may require cooling agents that depend on the correlated pulse. Cooling diaphoretics such as mint family are appropriate for a floating urgent pulse. If the pulse is urgent and tense, then skullcap might be considered. If it is weak, then organotrophics (amphoterics) should be used, select an agent which strengthens the corresponding organ. If it is weak or without root in the heart position (left 1st), a cardiotonic such as hawthorne berry or arjuna might be considered.

Jim Ramholz

Jim was a practitioner who was committed to the development of pulse diagnosis skills. James (Jim) Ramholz died suddenly on January 23rd, 2004, at the age of 52, doing the activity he loved most: treating patients in his clinic.

 

James Ramholz photo

Unraveling the Mysteries of the Nan Jing, Chapter Five

By William Morris, DAOM, PhD, LAc

The classics can be obscure, and may appear to have little clinical relevance. However, useful interventions can be discovered through study and contemplation. The question is not whether the resulting application is what the ancients intended, but whether the resulting clinical application is useful and can make a contribution to the field.

This paper discusses some practical applications of chapter five of the Nan Jing as found in Tu Ju Wang Shuhe Mai Jue Ba Shi Yi Nan Jing Bien Zhen (Pictorial Notes on the Pulse Songs of Wang Shuhe).1 The five-depth system is also discussed in other important texts of Chinese traditional medicine, including the Mai Jing (Pulse Classic)2 and Li Zhi Shen’s Pulse Diagnosis.3 While each text discusses the method of pressure to assess the five depths, none of these sources discuss the practical application of the method.

The Nei Jing and Nan Jing both describe three-dimensional models for pulse diagnosis. Each position represents a burner, as does each depth. The trick is making sense of this set of possibilities; the solution is to focus on each aspect, one at a time. For instance, if the distal positions are weak, this suggests depletion in the upper burner. (The nature of the depletion will depend on other signs and symptoms.)

Methodology

In chapter five, beans are used to signify the depth of pressure. “With a very light hand press superficially and then press harder; 1st depth is 3 beans pressure to the lungs and skin, 2nd depth is 6 beans to the heart and the vessels, 3rd depth is nine beans to the spleen and flesh, 4th depth is 12 beans to the liver and sinews, 5th depth is 15 beans to touch the kidney and bones.”4 Please note: depth is based on light pressure at the skin and deep pressure close to the bone, rather than using the vessel as the starting and ending point.  For instance, the fingers are not merely pressing at six beans of pressure to examine the heart; one is pressing with an intention to examine the vessels.

The table in Pictorial Notes on the Pulse Songs of Wang Shuhe from the Qing dynasty includes only the organ, weight, and tissue level. This table adds other correspondences such as the phase and the corresponding perception.

Table 1: Systematic Correspondences
Phase Organ Beans weight
in pressure
Tissue control
by organ
Sense
Metal Lung 3 Skin Smell
Fire Heart 6 Vessels Speech
Earth Spleen 9 Muscle Taste
Wood Liver 12 Tendon Sight
Water Kidney 15 Bone Hearing

 

Table 2: Three Depths and Five Depths Correspondences
3 beans pressure Heaven or qi depth Upper Burner Skin
6 beans pressure Vessels
9 beans pressure Human or qi depth Middle Burner Flesh
12 beans pressure Earth or organ depth Lower Burner Sinews
To the bone and lift Bone

This method can be reduced and made simple. Divide the region between the skin and the bone into three areas. This is the heaven-human-earth method. Then, the qi depth (heaven) is divided into Metal and Fire, while the organ depth is divided into Wood and Water.

Application The ability of an organ to control the tissues is another indirect suggestion that occurs in chapter five of the Nan Jing. For instance, the spleen’s capacity to control the flesh is evaluated at the middle depth. To examine the biceps, explore the middle depth in the right distal position. This provides information about the muscles and flesh along the trajectory of the lung vessel. As an alternative, use the middle depth (earth and spleen sector) in the proximal position to examine the musculature of the lower back.

There may be either excess or deficient signs at any depth. Even technique on the corresponding transport point will generally cause the anomaly to self-correct.

The operating premise is predicated upon fractal and holographic thinking. That is, a correction in a part will reflect corrections in the whole.

Applications of the Five-Depth Model

  1. Diagnosis
  2. Point selection
  3. Needle depth and breadth placement within a point

Diagnosis: A pulse with the Metal and Fire areas absent (qi depth) suggests a qi depletion pattern. It can also suggest that the capacity of the upper burner is diminished. The treatment is to select points, herbs and qigong to increase qi in the upper burner. Acupuncture could include tonification of back-shu or front-mu points; medicinals that supplement the qi of the heart and lungs are another possibility. Qigong methods include those that stretch the heart and lung vessels such as expanding the arms laterally so the angle of stretch is along the vessel. Cardiovascular exercise maybe recommended if appropriate.

Point selection: The depth where a depleted sensation or replete sensation is identified suggests a corresponding transport point on a channel. For instance, the left middle position corresponds to the liver orb of influence. If the pulse is floating and there is no root, needling the Water point on the Liver channel usually causes the root at the liver position to fill in.

Needle depth: The standard needle depth can be divided into five regions, and the region corresponding to the tissue layer is needled. The pulse can be palpated while the needle depth is adjusted to refine the depth of insertion. The distance within the point range can be divided into five sectors. The area closest to the bony landmark is the Water area – look for the most tender spot or palpate for the spot that corrects the pulse depth.

Case Example The patient is a 54-year-old female undergoing chemotherapy for breast cancer. Her pulse is thin and weak. (It was also absent at the Water depth in the left middle position.) The tongue is pink and thin; this is due to a qi and yin depletion pattern. She has fatigue, leukopenia, no appetite, and nausea. In addition, when she received typical TCM-style point selections such as Sp 10, St 36, Sp 6, Lu 9, and K 6 for a standard amount of time, she would experience a collapse of energy and remain in bed the whole next day. When the strategy of supplementing the liver Water point and supporting that treatment through the biao-li interior-exterior channel method, including Lr 8, GB 44 and SJ 5, was combined with corresponding mu points Ren 5, Lr 14 and GB 24, she felt relief, increased energy and diminished nausea. In addition, her leukopenia went from a count of 2,600 to 3,800 cells/µL/cu mm over the period of one week, with two treatments based on balancing the five depths of the liver position.

I would like to thank Christine Chang, a licensed acupuncturist and pharmacist at Emperor’s College of Traditional Oriental Medicine, for her assistance in translating chapter five of the Tu Ju Wang Shuhe Mai Jue Ba Shi Yi Nan Jing Bien Zhen.

References

  1. Aing Y. Tu Ju Wang Shuhe Mai Jue Ba Shi Yi Nan Jing Bien Zhen (Pictorial Notes on the Pulse Songs of Wang Shuhe). Yi An Tong, Shu Lin, Qing dynasty.
  2. Wang S. The Pulse Classic: A Translation of the Mai Jing. Blue Poppy Press, 1997.
  3. Zhen LS. Pulse Diagnosis. Brookline, MA: Paradigm Press, 1981.
  4. He WS. Wang Shu Tu Zhu Nan Jing Mai Jue (Wang Shu He Picture Chart Markings of the Nan Jing and Mai Jue). Jin Lun Tang, Qing dynasty.

 

Dr., Doctour, Docere – What’s in a Title? Doctoral Titles in Chinese Medicine

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Doctor Titles

By William Morris, DAOM, PhD, LAc

First published January, 2012, Vol. 13, Issue 01 Acupuncture Today

I would like to explore  doctor titles, and the historical use and impact upon programs and policy. It is time that people entering the AOM field, putting in four years of effort and often times the better part of $100,000 earn the title of doctor.

So, let’s take a closer look at what exactly that title means and whether doctorates fit into the world of AOM.

A Doctor defined

The term Doctor (Dr.) attracts confusion regularly. Learned people consider the doctoral education in U.S. AOM to be PhDs. They are not, at least for now. Then there is the OMD that ended in 1998 as the field sought accreditation for master level education. Now, we have a post-graduates specialty in the DAOM and a looming first professional doctorate: title to be determined.

The first doctorates were PhDs. According to The Oxford English Dictionary, the earliest written use of the English word doctor was in 1303, referring to doctors of the church, meaning “learned men in the scriptures.” In 1377, medical doctor as title for those who treat illnesses or diseases gained presence. Somewhere in the late 14th century, a church father enjoyed the title doctor as a religious teacher, adviser and scholar. In Latin, it was docere: to teach, in French, doctour. M.D. doesn’t arrive until 1755 in the abbreviation of L. Medicinae Doctor “doctor of medicine.”1 In Chinese, language Dr. is designated yshng, this is a professional medical practitioner in the tradition of Chinese medicine.

In contemporary western practice, there are several forms of doctoral designation with respective roles. Research doctorates have the title PhD. There are first professional doctorates that are achieved within the disciplines: educational doctorate (EdD), dentistry (DD), medicine (MD), physical therapy (DPT), chiropractic (DC) and law (JD). The AOM field is unique in that it has a post-graduate Doctorate in Acupuncture and Oriental Medicine (DAOM) with competencies in a clinical specialty plus a smattering of research and education.

The DAOM

Let’s review the requirements for the DAOM. All current DAOM programs require graduation from an accredited master degree program. After two years of undergraduate level education and 3.5-4 years of education at the master degree level, the DAOM can be earned with two years and at least 1,200 hours of education. This makes for 7.5-8 years minimum for doctoral level education in the AOM field, consistent with first professional degree education throughout the disciplines.

The DAOM program must provide a curriculum covering the competencies in the following core areas (2):

  1. Advanced patient assessment and diagnosis;
  2. Advanced clinical intervention and treatment;
  3. Consultation and collaboration;
  4. Clinical supervision and practice management;
  5. Clinical evaluation and research.

DAOMs require teaching skills (4. Clinical supervision). As an educator, this is an interesting area. In one DAOM program, the new cohort was surveyed about their willingness to precept (supervise learners in their clinics). Of some 15 learners, only one was interested in precepting. After the program, all but one was willing to serve as a preceptor. Seemed successful. This is an important area of contribution and it is not a competency that is likely to be pursued in first professional doctorate.

Should the Current Master Degree in Oriental Medicine be a Doctorate?

The average time to complete a PhD is 10 years with four years at the PhD level; two years master level education and four years of undergraduate education. First professional doctorates are different. The state of New York defines a first professional doctorate as two years of undergraduate study with four years of graduate education in the profession. While the PhD is typically 10 years, and it is possible to complete a first professional doctorate in six years, it is more likely that the undergraduate education is more substantial at four years. Thus, the first professional degree involves typically 7-8 years of education after high school.

Maybe we shouldn’t! Some school leaders argue against first professional doctorates because of the costs involved and concern that it could put a school out of business.

There are two primary reasons a school may fear failure should doctoral programs arise. First, the state in which the school operates may not allow for doctoral education. Second, many schools do not have the resources for developing doctoral level education. Thus, the uneven competition created by state laws and institutional capacity could cause schools to fail if students were to flock to available first professional doctoral programs. Ah! There is a third. Those schools that have put resources into developing DAOM programs at great expense may be concerned that a first professional doctorate would somehow cause interest to be lost in the DAOM program.

“But, there is increased med-legal risk for the acupuncturist to gain a doctoral title,” was a common refrain of AOM doctoral opponents of yore.2 That tune evaporated as the DAOM programs places graduates onto the streets and the insurance rates remained the same for that group as the master degree prepared practitioner. In my opinion, an improved educational standard lowers risk rather than increases it. A study that could highlight this view might be to explore the number of malpractice suits sustained by doctorally vs. masters prepared practitioners.

Who Cares?

I stand for doctorates in the field of AOM because I believe it is the right thing to do. It is a position that I have maintained since the early 80s’.

In Texas, where I live and work, there is no assurance that permission to grant first professional doctorates can be obtained. There is a risk. I continue to support first professional doctorates, because I believe it is right for the field, even if there is risk. As president of a school of AOM, my approach to leadership has been that what is good for the profession will be good for the school. This is the view when first professional doctorates are discussed within the Council of Colleges of Acupuncture and Oriental Medicine.

Power dynamics are leveled there is a common title among participants. Practitioners of Chinese medicine are often outside the mainstream currents in policy development, higher education and in the practice arena. Thus, AOM providers sustaining doctoral titles can serve a common social good, because the ability to influence access to care by the public is enhanced.

It is important for senior learners to teach junior learners, because it is through the act of transmission that senior learner learn! And, as John’s Hopkins medical educator said in the early 1900s, “There is no way we can teach them everything they need to know to enter practice. The best we can hope for is to inspire them towards lifelong learning.” Today’s master degree in AOM is more rigorous than the MD of 1900.

While it is the internal and not the external qualifications that make a practitioner, in the eyes of the other, rank can be a leveling tool. The doctoral title may help those who are dedicated to erecting this profession and what it has to offer both society and the patient. The doctoral title often enhances relations with community partners, patients and policy makers. For these reason, which are tied to creating just and equitable access to healthcare that is often times safer and more cost effective than post industrial medicine, it is important for the acupuncturist to gain doctoral recognition.

Comments on the first professional doctorate would be speculative since the standards are still subject to process including public hearings and input. The AAAOM operates a forum where voices can be heard. Go here: http://groups.google.com/group/aomcommunity?pli=1 to participate in dialogs about the development of a first professional degree. The dialog is open and uncensored.

Lastly – the term doctor may be gained by license title or earned degree and preferably both. The field of acupuncture has now embarked upon the process of taking this higher level of responsibility in society. Kudos!

References:

  1. Etymonline. Doctor 2011: Available from: www.etymonline.com/index.php?term=doctor.
  2. ACAOM Accreditation Manual: Structure, Scope, Process, Eligibility Requirements and Standards. Greenbelt, Maryland: Accreditation Commission for Acupuncture & Oriental Medicine; 2009.
  3. ACGME. ACGE Outcome Project. Minimum Program Requirements Language [serial on the Internet]. 1999: Available from: www.acgme.org.

Pulse Diagnosis Book: Li Shi-zhen Pulse Studies: An Illustrated Guide

Li Shen-qing is a doctor of Chinese medicine and widely published author in China, noted for his approach using tui na and pulse diagnosis in the clinic. Dr. Will Morris has been President and CEO of the Academy of Oriental Medicine in Austin (AOMA), has studied and taught pulse diagnosis since 1980, and was recognized as Acupuncturist of the Year in 2007 by the American Association of Acupuncture and Oriental Medicine.00

Order at Amazon: [easyazon_link asin=”7117137622″ locale=”US” new_window=”default” nofollow=”default” tag=”neocpulsdiag-20″]Li Shi-Zhen’s Pulse Studies – An Illustrated Guide[/easyazon_link]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7 Drugs Whose Dangerous Risks Emerged Only After Big Pharma Made Its Money

[fblike layout=”standard” send=”true” action=”recommend” font=”arial” colorscheme=”light”] Drugs have a place, as do herbs and other materials with healing properties. The greed of pharmaceutical companies is facilitated by the rotation of board members into governmental watchdog agencies such as the Food and Drug Administration. It is time for a revolution and escape from the idea that somehow, drugs and surgery provide the best forms of medical care. It is time to explore first foods and lifestyle, then other whole materials such as plant based medicine.

http://themindunleashed.org/2014/05/7-drugs-whose-dangerous-risks-emerged-big-pharma-made-money.html

Flexner to Eisenberg: The Turning of a Nation

By William Morris, DAOM, PhD, LAc

Abraham Flexner was a reformer of education, particularly in the area of medicine. He devoted much of his life to education, attempting to gain a better understanding of its place in society.1 It could be said that he changed the face of medical education in America with his 1910 report Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching.2 I would like to explore results on both sides regarding Flexner’s impact on medical policy and as a result, medical care.

Good as it was, Flexner’s report also may have been a part of the reduction of natural products in the U.S. healthcare environment between 1910 and the 1960s. That gap became obvious to policy makers when David Eisenberg’s study, Unconventional Medicine in the United States — Prevalence, Costs, and Patterns of Use, demonstrated the amount of money that Americans spent out of pocket on “complimentary and alternative healthcare.” We will explore this after considering Flexner’s work in more detail.

The Background
If one considers the centennial commemorative of Flexner’s work in a 2010 special edition of Academic Medicine, medical education improved. In it, Dr. Steven Kanter, the editor-in-chief, gave summary of the essays reflecting upon the past 100 years of a post Flexnerian world.3 Kanter’s summary focused upon balance as a common feature among the essays. Dialectics ranged from curricular content and the length of medical training, to the contrast between a “disease management” and “population-based health improvement.”4 Other areas of balance included professional or scientism and humanism, rural and urban care, lab time and patient time, and “the integration of formal knowledge of the basic, clinical, and social sciences with clinical experience.”5 Refreshingly, Lambert et al. argued for a balance between “standardized” and “personalized” scientific knowledge.5 The fundamental message was that Flexner was focused upon balance, as were the “Neo-Flexnerians” who published essays in the Centennial Celebration in Academic Medicine.

But, was Flexner balanced in his approach to seeking balance and improving education according to his worldview? Notorious for his harsh descriptions, Flexner also took rather extreme positions. Consider this section of the report, this one justifiably addressing the Georgia College of Eclectic Medicine and Surgery of Atlanta:
“The school occupies a building in which, in respect to filthy conditions, has few equals, but no superiors, among medical schools. Its anatomy room, containing a single cadaver, is indescribably foul. The pathological and histological “laboratory” contains a few dirty slides and ordinary microscopes . . . nothing more disgraceful calling itself a medical school can be found anywhere.”2

The Turn
Carnegie Foundation published and funded the 1910 Flexnor Report, which carved out and cleaned up national healthcare policy with respect to education and the medical profession, but at what cost? It was devastating for some. They were those who used competing medical models often with better results and stronger economics than the chemical-surgical focus of the medical schools supported by the report. Medical care in the U.S. was altered in such a way that indigenous knowledges as employed by eclectic physicians who used Native American traditional medicine were deleted from the standard of care.

Five criteria for evaluating schools were used by Flexner in order to develop his work. Here are those criteria: a) entrance requirements and adherence to them, b) the size and training of the faculty c) the sum and allocation of endowment and fees to support the institution d) the adequacy and quality of the laboratories as well as the training and qualifications of the laboratory instructors, and e) the relationships between the school and its associated hospitals. There were other criteria used to develop the Flexner Report such as full-time teaching faculty, pathological analysis of the human body and a physiochemical analysis of the human body.2 There are no records of who was involved with the process for developing the criteria.

What we know is that Flexner, an educator with no background in medicine, investigated 69 schools in 90 days. Here are the results of his work. Within three years of the release of the Flexner Report, 25 medical schools closed. Altogether, because of the earlier efforts and then the release of the Flexner Report the number of medical schools dropped from 650 to 50. Private hospitals declined in number from an estimated 2,441 in 1910 to 1,076 in 1946. 6 The 22 homeopathic medical schools that flourished in 1900 dwindled to just two in 1923. By 1950 all schools teaching homeopathy were closed. If a physician did not graduate from a Flexner approved medical school, he couldn’t find a job. New licensing laws required that medical schools be certified. Further:
• Schools that admitted Afro-Americans did not pass (except for two that admitted only Afro-Americans).
• Schools admitting Jews got lower than average grades (resulting in a 30 percent reduction in Jews graduating)
• Schools that admitted women got lower than average grades resulting in a 33 percent reduction in women graduating7
• Schools that were “commercial institutions” (able to function entirely by student fees) did not pass.
• By 1925 10,000 herbalists were out of business.
While Flexners ideals are espoused in reflection pieces upon him, it is also clear from the reults how the document was used. Conventional medical systems in America effectively excluded indigenous forms of medical knowledge from 1910 until the 1960s.

The ReTurn
The Eisenberg’s study, Unconventional Medicine in the United States — Prevalence, Costs, and Patterns of Use 8, showed that the US had began to recover from the losses created by the Flexner report. In 1990, there was an estimated 425 million visits to providers of unconventional therapy exceeding the 388 million visits to primary care physicians. Moneys spent were approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. $12.8 billion was spent out of pocket annually for all hospitalizations in the United States.8 The nation awoke from the sedating slumber of a Flexnerian ideal that had clouded the critical thought sphere.

Not long after Eisenberg published his landmark study, on Friday, December 6, 1996 the FDA announced the reclassification of acupuncture needles from class III (premarket approval) to class II (special controls). They identified the acupuncture needle as “a device intended to pierce the skin in the practice of acupuncture. The device consists of a solid, stainless steel needle. The device may have a handle attached to the needle to facilitate the delivery of acupuncture treatment.”9 Thus, the experimental status was removed from acupuncture needles.
Growth and change continued. On March 7, 2000, President William Jefferson Clinton gave executive order 13147, forming the White House Commission on Complimentary and Alternative Medicine Policy.10 Medical schools began including a consideration for nutrition and natural products.

The Summary
Flexner is arguably the grandfather of the “site visit” in medical education and higher education. The benefits of his work are clear, the U.S. has one of the strongest medical education systems in the world. The American public was divested of a more rich a plural form of medical care. Powers that be noticed in 1990 after Eisenberg’s study that people have mode complex needs than the corporate-technological forms of medicine. That trend was present all along and gained momentum during the sixties. Later studies that Eisenberg conducted have demonstrated that the growth of a plural medical system continues.

References
1. Abraham Flexner [cited 2011 August 5]: Available from: www.ias.edu/people/flexner.
2. Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. . Boston, MA1910.
3. Kanter SL. A Letter to Those Who Read This Issue in 2110. Academic Medicine. 2010;85(2):181-2 10.1097/ACM.0b013e3181cfbf6f.
4. Prislin MD, Saultz JW, Geyman JP. The Generalist Disciplines in American Medicine One Hundred Years Following the Flexner Report: A Case Study of Unintended Consequences and Some Proposals for Post-Flexnerian Reform. Academic Medicine. 2010;85(2):228-35 10.1097/ACM.0b013e3181c877bf.
5. Irby DM, Cooke M, O’Brien BC. Calls for Reform of Medical Education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010. Academic Medicine. 2010;85(2):220-7 10.1097/ACM.0b013e3181c88449.
6. Mark D. Hiatt MD, M.S., M.B.A. and Christopher G. Stockton, M.S.M. The Impact of the Flexner Report on the Fate of Medical Schools in North America After 1909. Journal of American Physicians and Surgeons. 2003;8(2).
7. Starr P. The social transformation of American medicine. New York: Basic Books; 1982.
8. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional Medicine in the United States — Prevalence, Costs, and Patterns of Use. N Engl J Med. 1993 January 28, 1993;328(4):246-52.
9. FDA. Medical Devices; Reclassification of Acupuncture Needles for the Practice of Acupuncture. Federal Register [serial on the Internet]. 1996; 61(236): Available from: www.gpo.gov/fdsys/pkg/FR-1996-12-06/html/96-31047.htm.
10. CAM WHCo. White House Commission on Complementary and Alternative Medicine Policy 2002: Available from: www.whccamp.hhs.gov/finalreport.html.

Rolling from Primary Positions: Seeking the Truth

Pulse Diagnosis

© 2004 William R. Morris, OMD, MSEd, LAc

In the 1950s, the Chinese government had masters of pulse diagnosis come together to compare their findings. There was such a disparity of results, it caused a reduction of the value of pulse diagnosis in the total scheme of the medicine. The role of pulse became a confirmation of that which had been concluded by questioning and observation. The additional time and effort required to master this topic did not fit into the demands of training a large body of physicians fit for practice. Thus, a set of common denominators was selected for the efficient training and delivery of the medicine. The more refined and subtle messages these various masters had identified were relegated into obscurity.

Many practitioners question the origin of rolling the fingers during pulse taking. The point of this article is to highlight the technique of rolling the fingers as classical, not a feature that is idiosyncratic to “special” systems. It is not only a product of antiquity or of some special lineage, but is written about and utilized by current practitioners of traditional Chinese medicine. Some examples include John Shen’s account of rolling into complementary positions. Aside from studies with John Shen, I have personally observed senior practitioners rolling fingers during the study of a patient’s pulse. During the course of teaching, I have had conversations with practitioners who claim that these methods are not “traditional.” However, when presented the citations that follow, they acknowledge there are doctors who practice this way.

Contemporary Authors
Tietao Deng mentions1 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.
Diagnostics of Traditional Chinese Medicine refers to a technique called sliding. It says, “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 There are clearly no secrets being revealed by this text, however, it does substantiate the presence of these methods in current mainstream literature.

Neoclassical Authors
Qi Bo’s answer to the Yellow Emperor was: “Within the cun opening, there is a division of the superficial and deep levels, proximal and distal positions, and the left and right sides”.3 This statement is found in chapter 13, book one of the Mai Jing, in which Wang Shu-he refers to specific subdivisions of the distal positions. However, Wang does not explicitly state the significance of these complementary positions as do Shen and Hammer. Wang follows with a discussion of five elemental relationships and the potential pathology. He is implying an elemental assignment to each of these subdivisions without specifying what the assignment is. In practice, I have assigned elements to each of Wang Shu-he’s positions. They are as follows: earth is center; water is proximal; fire is distal; wood is radial; and metal is on the ulnar side. This arrangement is clinically effective and consistent with some Dong Han style thinking.

In book ten of the Mai Jing, the hand diagram of the 31 positions, there is a discussion of diagnosis related to the extra meridians and the six divisions. The identification of the yin wei and yang wei pulses require rolling radial and ulnar to distinguish between the two. There are several references like “the outer side of the distal position” and “the inner side of the proximal position.” Wang has clearly stated the idea of these subsidiary positions.4

Soulie De Morant describes rolling in some detail in his tome Chinese Acupuncture. “Thus, for the heart, the upper (proximal) half refers to the ventricles and the lower (distal) part, the auricles. For the sexual organs, the upper part responds to the testicles or ovaries, the middle the fallopian tube or the penis, the lower part the uterus.”5 In the section on location, aspects and significance of each pulse, he describes the following: “Radial edge: right half of the body. Medial edge: left half of the body.”6

Dr. John Shen recommends rolling into five positions from each primary position as a general statement. Two are proximal, radial and ulnar sides of the main vessel; three are distal to the primary position; one in the middle, one radial and one ulnar from the primary vessel. However, in practice he gives specific organ or tissue relations to the rolling of one’s fingers into a position (see Hammer’s articles in American Acupuncturist).

The practice of pulse diagnosis requires a tremendous amount of study under the tutelage of an individual who has had the privilege of being guided by a master. Knowing the descriptions is not enough. Having years of experience is not enough.

The potential of pulse diagnosis is vast. I have personally identified histories of birth trauma; tobacco smoking; marijuana use; parasitic infection; enlarged heart; recent relationship troubles; and so on. This set of skills is no mystery; colleagues in the Shen-Hammer method have had the same results. A competent practitioner, properly trained, may reproduce these findings with diligent application of the method.

References
1. Deng T. Practical Diagnosis in Traditional Chinese Medicine. Churchill Livingstone, 1999, p. 90.
2. Long Z (chief editor). Diagnostics of Traditional Chinese Medicine. Academy Press, p. 145.
3. Shue-he W. The Pulse Classic. Translated by Yang Shou-zhang. Blue Poppy Press, 1997, p. 23.
4. Shue-he W. The Pulse Classic. Blue Poppy Press, 1997, pp. 351-61.
5. De Morant S. Chinese Acupuncture. Paradigm Press, 1994, p. 200.
6. Ibid, p. 301.

Path of the Pulse: diagnosis and treatment