Monday, May 9, 2011

Chinese Herbal Therapy

Shen Nong, The Divine Farmer: Legendary Grandfather of Chinese Medicine

"Medicinals should coordinate in terms of yin and yang, like mother and child or brothers. They may be roots, stalks, flowers, or fruits, and they may be herbs, stones, bones or flesh.

Some can go alone. Some need each other. Some mutually reinforce each other. Some fear each other. . . When combining, it is proper to use those that need each other and are mutually empowering."

Preface to the Shen Nong Ben Cao Jing (The Divine Farmer's Materia Medica), 300 B.C. - 220 A.D.



Huangdi, The Yellow Emperor


Yellow Emperor asked Qi-Bo:

"The laws of needling dictate that acupuncture should be, first and foremost, based upon the spirit. Blood, blood vessels, nutritive energy, vital energy, along with pure essence and the spirit, are stored in five viscera. When the five viscera lose energy due to imbalance in seven emotions and excessive desires, it will cause a loss of reproductive energy, a dispersion of mental strength, a confusion of will and intention, a deviation of decision and planning. Why is that?"


Qi-Bo replied:

"Virtue is what Heaven bestows on us. Energy is what Earth bestows on us. Life is a product of an interaction between the virtue of Heaven and energy of Earth. Reproductive energy is the source of life. The spirit comes about as a result of the struggle between the two kinds of reproductive energy. Mental consciousness travels along with the spirit; strength travels in and out with reproductive energy. Mind is responsible for the performance of activities. Intention directs the mind to perform activities. Will carries out the decision made by intention; deliberation studies the plans for fulfilling the wishes of will...”

Wen Acupuncture


Wen acupuncture needle in the needle after the end of the needle set Ai plus column, lit to heat the body transmitted to the body through a needle to a method of disease control.

    
This method first appeared in the Eastern Han Dynasty, Zhang Zhongjing's "Treatise on." Ming Yang Jizhou's "Great acupuncture" describes more details of this law: "The law on the needle points to the Hong Angelica for round cakes, set the needle to moxibustion of, and many more ... ... This method is to take effect the line and rank in the mountains person, the meridian by pathogenic cold, or effective, but just warm needle ventilation. "After the ages have used. This method is still widely circulated civil applications.

   
"How To"

    
① All preparations are the same acupuncture needles.

    
② in accordance with the acupuncture needle into a certain depth to find the sensor, the application of practices, so that patients get the feeling of tingling Shen inflation, leaving needle does not move.

    
③ loaded pintail wrapped in large or small, such as jujube date pit large moxa, ignition to burn. Ai volume or a cut of about 2 cm, inserting the needle end, ignition heating.

    
④ General Viagra warm needle 1-3 cone burning, warm feeling under the needle can be.

    
⑤ 15-20 minutes left needle, then slowly from the needle.

   
"Contraindications"

    
① Heat sexually transmitted diseases (acute infection such as fever and all, etc.) should not use the warm needle therapy.

    
② temperature and blood pressure should not use acupuncture.

    
③ Those who can not stay Syndrome needle, such as seizures, convulsions, tremor Dengjun should not use the warm needle therapy.

    
"Notes"

    
① wrapped in moxa needle tail coat, must be installed in order to avoid burning down Ai Group and Mars, causing burns.

    
② If the treatment with needles, equipment should be wrapped in the AI ​​group is small, due to stronger thermal needles.

    
③ ignited moxa should start with the bottom of the light, it will give the radiation and conduction heat straight down, and enhance treatment.

    
④ If the fire fall Ai, then Ai can blow the fire ground, or directly off. Also asked patients not to change position, so that the moxa needle wrapped with tail coat down, add to burn, but also to prevent accidents caused by curved needle. In order to prevent possible burns, around the needle in the skin temperature rubber mat or towel, clothes and so on.

    
⑤ Other considerations can be found in needle therapy and moxibustion therapy.

   
"Comment"

    
Acupuncture and moxibustion in temperature is the most common, and the most popular kind of patient therapy. The so-called "war with needles", in fact, refers to the temperature of acupuncture. Because of its remarkable curative effect, wide range of treatment, disease prevention and health care is a major good laws, therefore, have long been valued by physicians and patients are.

Acupuncture Anesthesia


Acupuncture anesthesia therapy, also known as "acupuncture meridian points of narcotic therapy", referred to as "acupuncture anesthesia therapy." It is based on meridian theory, according to surgical requirements of acupoints along meridians, acupuncture dialectical approach using an anesthesia with the patient fully awake during surgery, intraoperative physiological disturb less so after the body recover faster. This therapy is the inheritance and development of a new medical achievements made, but also for the application of modern scientific methods of meridian theory provides a new way.

    
The therapy was founded in 1958, Shanghai, Xi'an for the conduct of the relevant medical institutions to obtain satisfactory results tonsillectomy. After more than half of the rapid provinces in the country has caused strong repercussions. To the end of 1959, in Shanghai, Shaanxi, Hubei, Shanxi, Henan, Hebei, Jiangsu, Hunan, Jiangxi, Heilongjiang, Gansu, and Guangxi provinces to promote the application of the various subjects involving clinical types of surgery more than 90 species, but basically small surgery, brain tumor removal surgery, mitral valve narrow separation surgery, gastric resection, hysterectomy, splenectomy, and kidney and bladder surgery.

    
With acupuncture anesthesia depth clinical work, theoretical study is becoming more active. Determination of human pain threshold, electrophysiological studies of central nervous system, acupuncture, "De Qi" research, biochemical indexes, and the animal model, and acupuncture anesthesia during surgery the patient's psychological changes, have achieved varying degrees of results also contributed to the improvement of surgical results of clinical acupuncture anesthesia.

    
More than 30 years ago, acupuncture anesthesia experienced a sprout, the foundation, formation, consolidation period of four important clinical application of disease nearly 100 species, almost every variety of common procedures, application cases, more than 2 million cases. More importantly, theoretically explained the mechanism of analgesia of acupuncture anesthesia, acupuncture anesthesia, analgesia that has its material basis. This will acupuncture, anesthesiology, surgical and neurophysiological development of science have a major impact.

   
"Basic content"

    
A, preoperative preparation

    
1. Preoperative must first understand the patient's condition, medical history, neurological type and ideological situation in order to determine the program of acupuncture anesthesia, surgery, and then a full estimate of the situation may arise in operation, to prepare to take the appropriate measures.

    
2. Acupuncture anesthesia during surgery, the patient completely awake, patients will be required before the characteristics of acupuncture anesthesia, methods, processes and results be introduced to the patient to eliminate the concerns, get in close collaboration with patients.

    
3. Preoperative patient selection of points in the test needle, to understand "get air" conditions and tolerance to acupuncture, to determine the surgical method and to stimulate the amount of stimulation.

    
Second, the selection of points

    
Selection of points to easy to get gas, no pain, no bleeding, patient position comfortable, easy to operate by the principle of operation. Point selection method body acupuncture, ear, nose pins, needles and other surfaces. Is focused on the election body acupuncture and ear acupuncture points method.

    
1. The principles of body acupuncture points selected

    
Meridian selected fourteen main points to take the following three selection methods can be used alone, can also be used in conjunction.

   
(1) followed by the selection of points: According to the meridians of the over, attending clinics and theory, selection and location of incision, surgery is closely linked to organ meridians and acupoints.

   
(2) near Point Selection: Selection of surgical site near the acupoints.

   
(3) The Neural Theory of Point Selection: First, segment selection of points, the second is the distribution of neural stem selected points.

    
2. Auricular acupuncture point selection principle

    
Ear selection, selection of points to take the following three methods can be used alone, can also be used in conjunction.

   
(1) as the doctrine of election by dirty points: such as "lung skin and hair," when the skin incision and sewing the lung point: "Kidneys bone", orthopedic or thoracic surgery rib optional kidney point: "The liver opens into the eyes" , ophthalmic surgery and other desirable liver points.

   
(2) The selection of points according to the surgical site: the stomach, such as access points gastrectomy; take appendectomy appendectomy points; cardiac surgery such as core points.

   
(3) in accordance with the ear anatomy and physiology of neural control and selection of points: choice operative abdominal organs such as oral cavity, ear fans root point, due to the vagus nerve; election under the common points cortex can improve performance and reduce the visceral pain reflex, is guided by physiological role.

   
"How To"

    
1. Preoperative

   
Before surgery, the first time on the stimulation of certain acupuncture points, called induction, induction time is generally 20 to 30 minutes.

    
Induction can be divided into two general induction and focus induction. Induction is common to all points in order to stimulate a little longer; focus induction is the key to stimulate acupuncture points, 5 minutes before surgery.

    
2. Intraoperative

    
Surgery is generally light to stimulate the process of surgical site to stimulate acupuncture points may be suspended by a small stimulus to left needle; on the operative site to enhance the acupuncture points-sensitive sensor.

    
Techniques can be used in the method of intraoperative needle acupuncture, electrical stimulation can be applied. Needle technique, the body acupuncture should be combined lift and thrust and twisting; ear twisting only, not to mention plug. Needle frequency of 120 to 200 times per minute is appropriate, twisting range of 90 to 360 degrees, lift and thrust in the range of 5 to 10 mm. Requirements is always in the "De Qi" state. Needle requires skillful technique, uniform and stable. This is a basic knowledge of acupuncture anesthesia. Use of acupuncture, the incision point to dense wave-based high-frequency, low frequency continuous wave long-distance to the main points and stimulate the patient can tolerate the amount of moderate-intensity appropriate.

    
3. Adjuvant

    
Acupuncture anesthesia in the preoperative or intraoperative applications often require a small amount of adjuvant to improve the effectiveness of acupuncture anesthesia, the patients in the safest and most favorable conditions for surgery. Commonly used sedative, analgesic and anticholinergic and other drugs.

    
(1) preoperative treatment: usually 1 hour before surgery due intramuscular sodium benzene 0.1 g dual-bus, 15 to 30 minutes before surgery muscular or intravenous meperidine 50 mg. To reduce the respiratory and digestive tract secretions in patients 30 to 60 minutes prior to subcutaneous or intramuscular injection of atropine, scopolamine 0.5 mg or 0.3 grams.

    
(2) intraoperative treatment: surgery according to patient response and surgical cases, respectively, plus sedation, analgesics, local anesthetic or muscle relaxant agent. For example, in cutting the peritoneum, ligation of major vascular or visceral traction before, it is estimated there was a strong reaction of the patient may be asked to role with 1% procaine local anesthesia. Due to timing of surgery in the medication, the dose right, so as not to lose the initiative with the patient or accident. Patients must be closely observed in a an accident happens, immediately take effective measures.

   
"Contraindications"

    
The complexity of some of the lesions, adhesions are more extensive exploration of the case or need, especially on some of the more difficult of abdominal surgery, acupuncture anesthesia effect was not stable, care should be used with caution.

   
"Notes"

    
1. Acupuncture operation, regardless of technique or needle acupuncture, patients are able to tolerate the strong sense is appropriate, not too strong, so as not to affect the results.

    
2. Acupuncture anesthesia during surgery, the patient is awake, requiring surgery for a cutting knife, a needle knot, so steady, accurate, light, fast, to avoid duplication operation.

    
3. Acupuncture anesthesia for surgery in some cases or some aspects, there are still incomplete analgesia, muscle tension, visceral reactions, so be prepared adjuvant surgery. Medication it is necessary to grasp the opportunity, but also control the dosage and prevent side effects.

Acupuncture technique - edged needle therapy


  
Edged needle therapy is with a special three-prismatic stainless steel needle, puncture points or superficial blood network, released a small amount of blood to a method of treating disease.

    
The Bian-stone therapy from the ancient law Pricking evolved. Legend of the initial treatment is the use of Stone Fu Xi, Mi Jin "Kings" in reference to Fu Xi's "system of nine tasted a hundred herbs and acupuncture." "Via" recorded nine pins in the "front-pin" is the prototype of modern edged needle, "network thorn", "like needles", "leopard tattoo" and other laws, all belong to the scope of the law Pricking Blood . Current clinical application of edged needle therapy is widespread.

   
"How To"

    
First, the needle

    
Edged needle made of stainless steel, 6 cm long needle, needle handle thick, cylindrical, needle body was three-prism, three sides of the blade, the tip sharp.

    
Available high-pressure needle sterilized before use, can also be soaked in 75% alcohol for 30 minutes.

    
Second, acupuncture

    
According to the condition and location needs, the choice of the following types of acupuncture.

    
1. Prick method: hand edged needle, pointing the site of bleeding or collaterals to quickly penetrate about 0.05 to 0.1 inches, then quickly exit the hemorrhage for the degree. Do not close after the needle by needle, the blood flow, and gently squeeze points to help ejection. Subsequently, in order to suppress the pinhole sterilized dry cotton balls, rubbing bleeding.

    
2. Pick acupuncture: the treatment site using edged needle prick a small vessel, out of a small amount of blood.

    
3. Plexus puncture method: using edged needle concentrated in a smaller part of the prick to make a slight bleeding.

    
4. San Acupuncture: The edged needle around the local lesions were prick, according to lesion size, can sting more than 10 to 20 needles, acupuncture to be based on the depth of local muscle thickness, depending on the depth of blood vessels. From the periphery to the center of the ring lesions prick, to the new health and removing blood stasis, dredging the purpose by the Los network.

    
5. Diarrhea Blood: The upper parts of rubber tube ligation in acupuncture, so that local venous filling, the left thumb on the bottom of the assassination as part of this, local disinfection, was stabbed right hand edged needle aligned parts of the vein, the rapid penetrate about 0.05 to 0.1 inches deep, is about to exit the needle quickly, so that blood flow can also tap the upper vein to facilitate blood stasis discharge.

    
Third, the intensity and duration

    
Edged needle prick therapy intensity and the depth, scope and number of related bleeding. Light condition, the range of small, poor health of patients, should adopt the superficial stab, stab a small, micro-light stimulation of bleeding. Conversely, severe illness, and range, and physical well patients, should be deep puncture, spiny, more bleeding strong stimulation.

    
Course of treatment also depends on how much bleeding and the severity may be. General shallow stab microbleeds may be 2 or 1 day; such as deep stab more bleeding, bleeding per week 2 to 3 times, can be every 1 to 2 weeks bleeding 1.

   
"Contraindications"

    
Have high fever, acute inflammation and heart failure embolism, the caution scalp treatment.

   
"Notes"

    
1. Have a tendency of blood to the spontaneous, should not use this law.

    
2. Frail, qi and blood deficiency patients should not use this therapy.

   
"Comment"

    
Edged needle therapy on acute, hot, real, blood stasis, pain syndrome have a good effect. That its mechanism of conventional therapy to improve local blood running through to achieve detoxification, swelling and pain, through the meridians, line stasis dredge, Pinggan rate wind, soothe the nerves Dingzhi, refreshing the perverse effect.

    
Modern research on the mechanism of pricking reported quite rich, if scholars believe that acupuncture four sewing hole, put out a small amount of yellow liquid blood, in serum calcium, phosphorus increased, decreased alkaline phosphatase activity, help children with bone growth and development. And four joints can stab gut trypsin, pancreatic amylase and pancreatic lipase increased, bile secretion increased, and help digestion and absorption of food. Pricking was reported by changes in microcirculation can lead to physical stress melon, neurohumoral functions of the state, to achieve the purpose of inhibiting allergy. Some scholars believe that therapy can be adjusted Pricking immune function.

    
The therapy is simple, fast, safe and effective anti-inflammatory, reduces swelling, pain, heat and so on, there is a definite clinical effect.

Acupuncture The Magic Tai-therapy


Taiyi therapy, also known as "The Magic Taiyi therapy " is the use of drugs moxa moxibustion points to a method of treating disease.

     Ming Yang Jizhou of this therapy in the "Great acupuncture"in there records. Modern treatment of pain is still often this method.

    "How To"

     First, the drugs produced moxa

     Take moxa 100 grams, 6 grams of sulfur, musk, frankincense, myrrh, rosin, cassia twig, Eucommia, Citrus aurantium, saponins, Asarum, Chuanxiong, independent living, pangolins, realgar, Angelica, Scorpio of 3 grams, will be The above are fine, and even research into drugs. Mulberry Paper can be difficult to get a width of 40 cm square, smoothing. Moxa first and then take 25 grams, spread evenly on the paper; and then get the medicine the end of 6 grams, mixed in moxa, the roll tight. External egg painting, and then a layer of paste on the Mulberry Paper, two blank paper 1 寸许, twist tight top.

     Second, the facilities and methods

     1. with the end of dosing ignited moxa, Ai fire ten layers with cloth wrapped at one end, at the point on the ironing. If off, cooling, re-igniting the moxibustion. 5 to 7 times that moxibustion.

     2. in the several layers of tissue covering the site of moxibustion or cloth, and then ignited moxa across the paper or cloth, simply press the point, the remaining 1 to 2 seconds. Then press the other points. If you put out the fire rekindled. About 10 times each by moxibustion.

     These two methods can be arbitrarily selected.

     "contraindications"

     Heat syndrome, yin deficiency should not use this therapy.

    "Notes"

     1. head, face, facial features, large vessels were cut moxibustion.

     2. lumbosacral pregnant women, abdominal ban moxibustion.

     3. use of this therapy should be taken to avoid personal injury phenomenon.

     4. use of this therapy is best able to prepare two moxa to burn a time, immediately connected to another, so that fire stopped working, the better.

    "comment"

     At present, the extensive use of Moxibustion is actually "The Magic Taiyi"or"The Magic thunderbolt" evolved. Is different from "The Magic Taiyi" moxa and moxa is made ​​of multi-herbal medicine, and general moxa moxa only as the main, mixed with small amounts of drugs are made. In addition, in operation between the two are different.

Acupuncture intradermal needle therapy


Intradermal Needle also known as "buried needles", is 30 or 32, made of stainless steel wire pushpin type and grain type of the two needles.

    
Intradermal acupuncture is an ancient method of acupuncture needle for the development. Is the needle piercing the skin, the fixed retention period of time, the use of its continuing stimulus, a method to treat the disease. Law can continue to stimulate acupuncture points to reduce the trouble of repeated acupuncture, the patient can also pin your hands and burying to enhance stimulation.

   
"How To"

   
(A) of the pushpin-type needle intradermal needle buried: pushpin-type needle, also known as intradermal press needles, ear and body points for burial. In the local routine disinfection, the clamp pin handle grip, alignment points, the vertical piercing, the ring handle needle flat to stay in the skin, with adhesive tape fixed.

   
(B) of the grain-type buried intradermal needle acupuncture: acupuncture points can be applied to most of the body (some made of tadpole-type intradermal needles.) Needle with sterile forceps gripping handle, align the points have been disinfected, 0.5-1 cm along the skin piercing, needle handle to stay in the skin, the use of tape fixed. If no intradermal needle, needle nothing can replace it with 5.

   
(C) buried needle time: two or three days is appropriate. Proper length of time the fall point of the short summer, the appropriate point. 2 buried pin interval: the same points 1 week after the needles can be re-buried needles, different acupuncture points can be continuous. For pain, illness, buried needle time for the degree of pain relief may not necessarily continue for several days.

   
"Contraindications"

    
Joints, local swelling, purulent infection at the skin, purpura, and scar, are not buried needles. Patients with skin allergies, bleeding disorders should not be buried needles.

   
"Notes"

    
① points, needles, tweezers have regular disinfection.

    
② buried needles at the appropriate water immersion. Summer sweating, you should check whether the Khan buried dip needle at the skin redness. See, for redness, pain should be checked in time, the phenomenon of infection immediately to take needles. Occurrence of pain in needle buried depth of the needle can be adjusted, the direction of adjustment is not valid, there may be inflammation, should take needle.

    
③ patient can press the needle handle with your fingers break, in order to enhance the amount of stimulation to improve the results. It should be noted hand hygiene.

    
④ If the infection has occurred at the buried needles, surgical dressings should be given routine treatment. If fever and other systemic reactions, appropriate antibiotics, or medicine detoxification drug treatment.

Cross Lake Bridge eight thousand years ago our ancestors had mastered the original acupuncture


  
The picture shows the site of A-shaped cross-lake bridge vertebral bone, B bone-shaped vertebral
Cross Lake Bridge unearthed part of the bone, wood and was very similar style of acupuncture needles, Department of Earth Sciences, Zhejiang University, Professor Liu Zhiqing study concluded: Cross Lake Bridge has mastered the original ancestors have been found than acupuncture needles of Stone early 4000 years
Cross Lake Bridge for some bizarre unearthed bone and wood, archaeological experts still can not explain their purpose. Department of Earth Sciences, Zhejiang University, Professor Liu Zhiqing has been engrossed in studying these objects, most recently, he found some bone awl, bone screws and wood shaped cone, peg-shaped device modeling and the later is very similar to acupuncture needles, and infer : eight thousand years ago, the bridge across the lake who already know how to eliminate the disease by acupuncture.
It is understood that medical acupuncture is the oldest part of two thousand years ago a book of the "Yellow Emperor" marks the acupuncture to establish a more complete theoretical system. According to archaeological records, burial site of Longshan Culture in Shandong Rizhao unearthed two stone needle, its tip is tapered and rounded triangular tip. The two cases of the late Neolithic period of Stone, an early acupuncture needles, it is found to push the history of acupuncture before and dating back four thousand years ago.
So early as eight thousand years ago the bridge across the lake to whether acupuncture might know the original technology? In this regard, Professor Liu Zhiqing answer is yes, he says, Chinese medicine generally believed that some acupuncture treatment from the fisheries of the eastern coast of the main people. "Yellow Emperor" has been recorded, said: "The people addicted to eating fish and salt, all the security of their office, the United States of its food. Fish enthusiastic people. Salt, wins blood. So the Min Jie Reorganizing the black, the sick are all painful ulcers, Expelling of Stone. so Bian stone, also from the east. "In other words, the eastern coastal fishermen like to eat salted fish, because fish easy to poison the body produces heat, resulting in a number of abscesses grow, and acupuncture treatments that can cure this just toxic heat. From the time of the ancient geographical environment, Xiaoshan Cross Lake bridge cultural sites on the coast, with the invention of the early environment and conditions of acupuncture. Current archaeological research shows that when the bridge across the lake not only know how to make the world's oldest canoes and fishing nets, have mastered the technology world's first salt, then by virtue of their intelligence and wisdom but also can master the technique of early acupuncture treatment.
However, in the cross-lake bridge cultural relics excavated from the site, the experts did not find of Stone. In this regard, Liu Zhiqing through bone and wood unearthed a large number of comparative studies, and finally found some in the excavations in the same shape with the artifacts of Stone, the main bone cone shaped bone screw, dowel shaped. Professor Liu told reporters that the ancient varieties of acupuncture needles, "nine needles", where "front-pin" needle body was three prism, three sides of blade tip, the modern and more for the "bloodletting" and cross the lake bridge cultural relics unearthed Some bone was three-cone prism, with the front needle shapes are very similar. "Chi-pin" is usually made of metal, made of hardwood or bone, without the sharp tip of the tip, do not generally do not force a thorn into the skin. Bridge across Lake unearthed some nail shaped thick limb bones from the bone wall sawing, grinding together, form rounded, regular, light the wall, the tip is blunt to be used as a long, nail-shaped the surface also presents a long-term play is like a jade package after the slurry. It is similar to the role and Chi-pin, are focused on pressure points hard skin puncture, but not punctured, excavated over the same period is the same dowel shaped structure. Cross Lake bridge cultural relics unearthed acupuncture needles than the site of Longshan Culture in Shandong Rizhao Bian stone tombs excavated 4,000 years earlier, and cultural sites from the cross-lake bridge the cultural layer of distribution, the "acupuncture needles," there is a tip shape evolution, which shows the ancient acupuncture techniques are continually explore and improve.

Cosmetic Acupuncture techniques


Acupuncture and Moxibustion is clinically used to stimulate acupoints in a specific method, acupuncture weight loss clinic doctors and beauty technicians must master the skills. Acupuncture needles are different sizes acupoints to stimulate certain parts, using various means to stimulate qi, the body organs function to adjust and improve the operational status of blood meridian, to cure disease and obesity damage the purpose of compatibility; The moxa moxibustion is the use of certain drugs such as temperature and burns, smoke ironing surface acupoints or certain parts are the role through the meridians and acupoints to treat disease and obesity capacitive loss, played the role of beautifying the face and body . Acupuncture and moxibustion for treatment in clinical application often combined, so collectively known as acupuncture cosmetic weight loss.
    
With the continuous development of society and science and technology, Chinese medicine meridians and acupoints based on traditional acupuncture and modern science combine to form many new acupuncture and moxibustion, such as: acupuncture, laser acupuncture, skin needles, intradermal needles, thorns blood method, embedding method, etc.; the traditional meridians, acupoints theory and modern medicine, biology, and formed part of acupoints in a specific and has a specific new therapy of acupuncture treatments, such as : ear acupuncture therapy, hand, foot acupuncture, facial acupuncture, laser acupuncture, catgut embedding the new law and so on.
    
Cosmetic acupuncture method, both in the clinical use of traditional acupuncture, but also some stimulation of the use of modern methods, and often also a combination of both. Since the methods are different, the specific operation and scope are different. In addition to the clinical treatment of cosmetic acupuncture loss capacitive disease, but also can be used for health care, beauty anti-aging. To minimize the suffering of patients, does not destroy normal tissue, requires highly skilled doctors and technicians to master the techniques of acupuncture and moxibustion, cupping and so on, repeated training, to grasp a variety of treatment to clinical flexibility and treatment, with ease to achieve the purpose of comprehensive treatment and care.
    
Beauty salon in general is more healthy to face the crowd, and the hospital's acupuncture are different, so that very wide range of applications. Cosmetic acupuncture method, safe, convenient, less painful, non-toxic side effects, if the same time with the corresponding Chinese beauty products, often receive very good treatment and health effects.

    
Cosmetic acupuncture meridian theory is guided by the combination of drugs and acupuncture, stimulation of specific acupoints and meridians on the skin, to restore balance to yin and yang organs blood, body fluid regulation function of the human endocrine and nerve to achieve cosmetic results. Especially for acne, chloasma, skin allergies, eczema, flat warts, alopecia areata treatment has its effect, popular people welcome.

    
Acupuncture Chinese medicine commonly used in topical cosmetic, Acupuncture, auricular pressure, cupping, injection, laser acupuncture, moxibustion and other smoked. Clinically to vary point prescription election, done well and there are laws and flexible. The meridian theory as a guide, the main acupoints along meridians; also based on personal physical fitness, body to the Ministry of acupoints far; also contours of the face, muscle to fat distribution and flexible point selection.

    
Such as acupuncture therapy adapted to acne, chloasma, skin allergies, hives, eczema, etc.; Auricular therapy adapted to the flat wart, allergic skin diseases; thorn pulling therapy adapted to alopecia areata, the limitations of dermatitis, chronic eczema, etc.; water injection , moxibustion therapy for treatment of chloasma smoked; pricking blood therapy is used to boil swelling, folliculitis, acne.

Magic of the Ancient Acupuncture


The legendary miracle-working doctor Bian Que acupuncture treatment can be used thousands of years, people have to explore this wide. Mysterious origin of Chinese medicine, acupuncture and when it? There is a legend: a hunting people in ancient times in the stone on the nose, the thorn is healed healed hunters long headache. The legend seems magical, but not without reason, this medicine can be traced back to the Stone Age origins seems, because in different parts of the Stone Age ruins, are used to poke the skin unearthed a large number of sharp stone tools.
Acupuncture in the Qin and Han Dynasty have been fully developed. The spring of 1993, Mianyang City in Sichuan Yongxing Town, Double Bun Han II excavated after the wooden outer coffin tomb room, unearthed a heavy black lacquer coated with a small wooden dolls, which bore some acupuncture meridians straight path but did not mark the location of text and Meridian, using only red paint line to show these paths, particularly in the wood under the clear-cut and color contrast. This is by far found in the world marked the first note of the wooden body meridians flow model. Was unearthed in Changsha, the Book "meridians." The book discusses the eleven meridians of the body through the line, the main ancient disease and moxibustion moxibustion. This is also the theoretical basis of the medical school of the ancient literature of the meridians. In addition, there is a Collection of Ancient Chinese medicine is the "Yellow Emperor", which is the Spring and Autumn and the Western Han Dynasty, many ancient medical scientists valuable lessons learned, accumulated medical achievements of the era. Which describes nine different needle, by use of points, nine pin can be divided into a large needle, long needle, needle, circular needle, needles and other types of front. The needle length of 3 cm to 24 cm range. The book series has cure various ailments and disease approach 365 acupuncture points, and one by one name. The book pointed out that the day lilies though expensive, but because there is stimulate the body's functions, so the treatment of certain diseases is particularly effective. The needles were significant sedation. Hebei Han tomb of Liu Sheng, Zhongshan has four lilies, five needles, can recognize a gold needle, needle and silver front circular needle, and some are broken and can not identify the needle.
Although the implementation of a variety of ideas by the emperor, "Yellow Emperor" of the medical method. However, there are many ancient Chinese emperors, on the physiology, the nervous system in particular has a strong interest. For example, the 1st century AD is said Wang Mang Yu Tu doctors and the assistance of a rival who had cut the body, with thin bamboo sticks to study human nervous system. Similarly, 1000 years later, Huizong hired a painter to paint a criminal by the bifurcation of human organs. Before the Huizong, Renzong called craftsmen created a bronze, copper, humans show the body's entire nervous system. The bronze is also used as a medical officer of Hospitals acupuncture guide student learning and physical examination. According to records, where acupuncture students at examinations should be subject to the copper outside the human body waxing, to pour into the body, who asked to be examined by the designated point needle, under the needle is accurate, then the wax breaking water, otherwise there is no water out This is a good means of testing the students. CLASSICS once a coma due to illness, physician helpless, and had to find a private doctor for acupuncture. The doctor used a needle into the unknown Renzong points behind, just a needle, Renzong to wake up, open your eyes, repeatedly praised: "Good Xing Xing!" Praise skillful, "Xing Xing" is clever at the time meaning, "Xing Xing Points" will be the resulting name. In the ancient books, like many examples of this innovation. Treatment of systemic paralysis, the woman giving birth, children with umbilical wind, abdominal pain, chest pain, headache, rheumatism, back to life and even facial features and other diseases, acupuncture can do.
The invention of medicine, acupuncture, the ancient people of our country's contribution to world medicine, but it is really why so many effects have to be further studied.

Mystery of the Western acupuncture trial solution


Over the years, acupuncture has plagued the Western medical experts, it is not surprising. Acupuncture theory, there is something called "gas" the invisible life energy meridians in the body 14 to run back and forth, while the pain is due to the gas block and the imbalance caused. Acupuncturists believe that in some specific points on the human body into the needle, can help smooth the meridians to treat all diseases, from arthritis and asthma to anxiety, acne and infertility to name a few.
It sounds a bit like a fairy tale, but acupuncture does have an effect on the human body, and scientists are using high-tech means to record one of the process. Neuroimaging studies have shown that acupuncture seems to calm the brain that register pain and activate those involving rest and recuperation area of ​​the brain. Doppler ultrasound shows that acupuncture can increase blood circulation of the treatment site; infrared thermal imaging technology shows that it can promote inflammation subsided.
Scientists also found that the ancient concepts and similarities between modern anatomy. 365 acupuncture points correspond to the nerve and muscle bundles, several meridians major arteries and nerves. Jacksonville, Florida (Jacksonville) Mayo Clinic (Mayo Clinic) pain control and rehabilitation experts, Peter. Multi Shell (Peter Dorsher) said that heart attack patients, the pain will radiate to the chest, and down to the left arm, which It is the trend of the Heart Sutra. Gallbladder pain may radiate to the upper right shoulder, this is the gall bladder meridian goes. "
Of course, there are still many medical experts acupuncture deeply skeptical about the efficacy of acupuncture research have been mixed. "You put the needle into a patient will be some measurable things  I am not surprised." University of Exeter (University of Exeter), Professor of complementary medicine, "trick or a treat" (Trick or Treatment) of the book Edzard. Ernst (Edzard Ernst) said that acupuncture "clearly has a strong role in the psychological comfort, but whether there are other effects, inconclusive."
Even so, the application of acupuncture continues to expand ─ ─ often as conventional medicine. U.S. armed forces doctors are using acupuncture to treat musculoskeletal problems, pain and stress symptoms, whether the hospital in the United States, or in the theater hospital in Iraq and Afghanistan. Acupuncturists Without Borders Association (Acupuncturists Without Borders) to the earthquake victims in Haiti for free ear acupuncture to help relieve their stress. Major medical centers ─ ─ from the MD Anderson Cancer Center in Houston (MD Anderson) to New York's Sloan. Kaide Lin Memorial Cancer Center (Memorial Sloan-Kettering) ─ ─ use acupuncture to reduce side effects of chemotherapy.
United States Government under the National Center for Complementary and Alternative Medicine (National Center for Complementary and Alternative Medicine) 2007 survey year, 320 million Americans in 2006 had received acupuncture ─ ─ more than 2.1 million in 2001 increased.
The most common areas of acupuncture when conventional medicine fails in the treatment of chronic pain, such as arthritis, low back pain and headache, are also often used to treat fatigue, anxiety and digestive problems. Acupuncture $ 50 per session, relatively inexpensive, and some insurers also reimburse the costs.
In general, acupuncture is relatively safe. Only 10% of patients in the acupuncture course there are some bleeding, but only in very rare cases, vital organs will be because of infection or injury, a fatal situation.
Most states require that acupuncturists be licensed to practice, the U.S. Food and Drug Administration (Food and Drug Administration) requested acupuncture must use new and sterile needles.
Acupuncture diagnostic process more complex. Acupuncture physician examine a patient's tongue, and take three on each wrist vein, and asking questions about diet, sleep habits, etc., before determining where the meridians may be blocked and where to do acupuncture. The 14 meridians are rivers of China, and 365 points may represent the year of 365 days. Wind, cold, heat, dampness, and other "enemies" will cause the disease, while gold, wood, water, fire, earth, five phases will make people sick.
"Acupuncture treatment is not similar to the" Merck Manual "(Merck Manual) that the standard treatment process," Joseph. Holmes (Joseph M. Helms) said that his Berkeley, California (Berkeley) in the medical center has trained about 4,000 acupuncturist. "Every treatment must be assessed according to individual circumstances, the statement by the patient and the physician's knowledge and experience of acupuncture."
Dr Holmes said, Western medicine also check the patient's tongue for signs of illness. For the "gas", he said, although the word does not exist in Western medicine, but a similar concept. "We will say that the 27-year-old woman in a near-death state, no response to external stimuli. Or say the 85-year-old woman's eyes hollow. It is also talking about the same energy and vitality, but it did not a category separate to quantify it. "
Early 20th century, 80 studies have found that acupuncture produces its effects in part because of stimulation of the body to release endorphins (endorphins), which is a pleasant feel of natural compounds, like the kind of post-exercise comfort.
McMaster University, Ontario, Canada (McMaster University) Project Director acupuncture Alai Jane Rohe. 艾罗里亚加 (Alejandro Elorriaga) said that now, more and more studies have found that acupuncture treatment may have several mechanisms at the same time exist, including the promotion of acupuncture parts of the blood circulation and tissue regeneration, control of pain to the brain sends nerve signals, and restart the control of heart rate, respiration and digestion and other functions of the autonomic nervous system unconscious. The project is a professor of modern acupuncture.
"Whether the west or east of the medical thought, as long as you accept acupuncture treatment, you will get some results." 艾罗里亚加 professor said.
In addition, when the acupuncture needles into the body and rotated, it will produce a strange phenomenon: According to the University of Vermont (University of Vermont) in the ultrasound study, connective tissue wraps around acupuncture needles, like spaghetti around a fork, the same. Irina neurologist. Lange Man (Helene Langevin), said action of acupuncture stimulation of the connective tissue cells, like massage and yoga to them, and may form a acupuncture meridians, send signals to the body. She said: "This is the direction we want to study next."
At the same time, Boston's Massachusetts General Hospital (Massachusetts General Hospital) Center for Biomedical Imaging Martinos (Martinos Center for Biomedical Imaging) neuroimaging studies have shown that acupuncture can affect the brain of a nervous system, including the slow edge system (the brain's emotional center) of neural activity, and stimulate the brain may play a role in the break area of ​​some neural activity.
Martino Centre shown in other studies, people with carpal tunnel syndrome (wrist pain caused by nerve compression symptoms) of patients, their brain sensation and fear of the regional activities, but after acupuncture treatment, the brain neural activity closer to healthy people.
Patients with fibromyalgia brain scans showed that acupuncture and sham acupuncture (acupuncture in random physical) cause the body to release endorphins, but the real acupuncture treatment also increased the pain neurotransmitter receptor number, give the patient more comfort.

The Significance of Pulse Diagnosis in the Modern Practice of Traditional Chinese Medicine

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?
Several years ago, an acupuncturist in the U.S. wrote to me saying:
I've been practicing for over five years now and have a busy practice; but, I'm totally disheartened about my abilities. The biggest difficulties are diagnostic. I graduated school as one of the best students in my class, yet neither I nor any of my classmates had any clear sense of tongue or pulse diagnosis. I've gone to endless seminars, but theory isn't doing it for me. All the theory is useless if you're unsure of your diagnosis. What I need is an experienced practitioner to work with who can and will tell me if what I'm seeing on the tongue and feeling in the pulse is correct. Otherwise, I feel as if I'm fantasizing all the time. Is that what Chinese medicine is all about?
This practitioner has recognized something that many others, who feel more confident despite limited training, may ignore: there is a great potential to simply "fantasize" the diagnostic signs, that is, to read into it something that is not really present. But, this is not what Chinese medicine is about; rather, there is a clearly defined method of pulse taking (and tongue examination, as well as other important diagnostic techniques) that can lead to reasonably well-defined syndrome determination.
The information presented below is aimed at examining the traditional and modern roles of pulse diagnosis, the techniques for taking the pulse, the interpretation of various pulse forms, and some of the controversies that exist regarding the use of pulse diagnosis.

THE ORIGINAL PLACE OF PULSE DIAGNOSIS IN THE CHINESE TRADITION

Pulse diagnosis is one of the original set of four diagnostic methods that are described as an essential part of traditional Chinese medical practice (1). The other three diagnostic methods are:
  • inspection: general observations of the patient, including facial expression; skin color and texture; general appearance, and the shape, color, and distinctive markings of the tongue and the nature of its coating; and smelling (noting any unusual smell of the body, mouth, or urine);
  • listening: to the quality of speech (including responsiveness to questions, rapidity of talking, volume of the voice); to the respiration; and to sounds of illness, such as coughing, gurgling from the intestines; and
  • inquiring: obtaining information about the patient's medical history and their symptoms and signs, such as chills/fever, perspiration, appetite and dietary habits, elimination, sleep, and any pains; also, for women inquiring about menstruation, pregnancy, leukorrhea and other gyno-obstetric concerns.
All of these diagnostic methods yield information that helps to determine the syndrome and constitution to be treated. While the Chinese pulse and tongue diagnosis methods, because of their frequent mention and somewhat unique quality among traditional medical systems, receive much attention, the other aspects of diagnosis cannot be ignored or downplayed.
The Chinese term indicating a blood vessel or a meridian (which are two interlinked concepts; see Drawing a concept: jingluo) is mai, and the same term is used to describe the pulse. Pulse feeling is called qiemai, which is part of the general diagnostic method of palpating or feeling the body: qiezhen [feeling method].
Pulse diagnosis is mentioned in ancient texts, such as the Huangdi Neijing and the Huangdi Neijing of the Han Dynasty period, but with only sporadic mention of various pulse forms and their meaning. In the Huangdi Neijing, pulse is depicted primarily as a means of prognosis for impending death. As an example, in the section of the book on yin and yang it is said that (2):
A yin pulse that shows no stomach qi is called the pulse of zhenzang [decaying pulse] and the prognosis is usually death. Why? Because a yin pulse reflects absence of yang and thus absence of life activity. If you can distinguish the presence or absence of the stomach pulse, you can know where the disease is located and give the prognosis for life or death, and even know when death might occur....When yang pulses are absent in a patient, the yin or the decaying pulse of the liver is like a thin thread on the verge of breaking, or like a tightly wound wire about to snap. The patient will die within eighteen days. If the decaying pulse of the heart is like a thin fragile thread, the patient will surely die within nine days. If this pulse is found in the lung pulse, the patient will not survive longer than twelve days. If it is found in the kidney pulse, the patient will die in seven days. If it is found in the spleen pulse, the patient will die in four days.
A more complete prognosis involves coupling the information about the pulse with the examination of the facial color and the "spirit" expressed by the facial expressions (especially the eyes). In the Neijing, it is said that: "In diagnosis, observation of the spirit and facial color, and palpation of the pulses, are the two methods that were emphasized by the ancient emperors and revered teachers...." As a text expounding on the virtues of the ancient teachers, there were complaints about failings of the modern practitioners in their diagnostic work, which echoes forward to the modern era. The practitioners of the time were encouraged not to forget the other necessary diagnostic methods, especially inquiry:
Today, doctors deviate from [the treatment methods of ancient times]. They cannot even follow the changes in the four seasons [that influence the pulse and other body conditions]. They do not know the importance and principles of the complexion and pulses....Doctors today should eliminate their bad habits and ignorance, open their minds, and learn the essence of pulse and color diagnosis [i.e., analysis of facial colors]. Only by doing so will they ever succeed in reaching the level of the ancient sages....There is one other important thing. That is the interrogation of the patient, the inquiry....Select a quiet environment; close all doors and windows; gain the trust of your patient so that the patient can completely convey everything that is pertinent to the condition. Be thorough and differentiate the truth.
In the Huangdi Neijing (3), the pulse is mentioned briefly and simply among a list of symptoms that would indicate a particular disease stage or category; thus, for the taiyang disease, the pulse is floating, for a yangming disease, the pulse is large, and for the jueyin disease, the pulse is feeble. In the companion volume Jingui Yaolue, there is more description of the pulses and some explanation of their meaning. For example, it is said that:
A pulse too strong or too weak denotes illness. A minute pulse on the cun site and a chordal pulse on the chi site portends thoracic debility and aching because it reflects an extremely weak condition of yang in the upper warmer. Heart pain follows the thriving yin evil as characterized by the deep chordal pulse.
The presentation of diagnostic information in these works of Zhang Zhongjing confirms the importance of inquiry, since it is by this means that one learns the essential features described throughout most of the text, such as location of pain, duration of disease, and other factors that determine the selection of herbs (thirst, mental conditions, urination, etc.). In his preface to the Huangdi Neijing, Zhang continues the complaint expressed in the Neijing about practitioners in his time, a century or more after the Neijing was produced in the form we have currently:
Physicians today do not thoroughly study the medical classics before they begin to practice, but merely follow their predecessors with no attempt to improve age-old forms....They take the front pulse, but not the rear; check the hands, but not the feet; and do not make a diagnosis of the complete upper, middle, and lower parts of the body. How can a pulse alone and careless observation tell about all the syndromes and diseases?
The concern is about incomplete and careless diagnosis, particularly where the pulse is the primary diagnostic method (omitting or minimizing the others), and failure to carry out the full pulse taking (front and rear pulses). This is a theme that persists throughout Chinese medical history, and applies to modern medical diagnostics as well (where medical doctors are chided for having missed a diagnosis by not performing all necessary tests or by carelessly interpreting the test results). The proclaimed failings in the Han Dynasty times, an era regarded by subsequent authors as one of the high points of Chinese medicine, illustrate that the reverence for the past is aimed at the wise instructions of the small number of highly accomplished scholar physicians (who left behind the classic texts), rather than the state of medical practice as a whole. The desire, which can only be professed and never fully accomplished, is that all physicians should attain the highest possible standard and should master the diagnostic methods through diligent study of the classics and continual attention to detail.

THE PULSE CLASSIC

The subject of pulse diagnosis was first tackled in an organized manner by Wang Shuhe, who lived during the 3rd century A.D. (just after the fall of the Han Dynasty). Wang was responsible for recovering and organizing the Huangdi Neijing (see: A modern view of the Huangdi Neijing); he may have fully rewritten the first three critical chapters. His text on pulse diagnosis became known as the Mai Jing (Pulse Classic). Although the text had been regarded as quite difficult to understand, and was therefore often replaced by simpler, derivative tracts, it has, in modern times, been deemed a classic worthy of preservation. A translation of the Mai Jing, based on a modern Chinese edited version, has been published by Blue Poppy Press (4).
In the Mai Jing, a broad spectrum of applications for pulse diagnosis is delineated, including etiology of disease, nature of the disease, and prognosis. As an example of etiology and disease development, it is said that: "If the pulse is bowstring, tight, choppy, slippery, floating, or deep, these six point to murderous evils which are capable of causing disease in various channels." As an example of disease analysis, the following pulse characteristics and implications are given:
If its emerging and submerging are equal, this is a normal state; if its submerging is twice as long as its emerging, this is shaoyin. If its submerging is three time as long as its emerging, this is taiyin. If its submerging is four times as long as its emerging, this is jueyin. If its emerging is twice as long as its submerging, this is shaoyang. If its emerging is three times as long as submerging, this is yangming. If its emerging is four times as long as its submerging, this is taiyang.
As to prognosis, an example with great specificity is: "If, on the seventh or eighth day, a febrile disease exhibits a pulse which is not grasping-like but beating rapidly at a constant pace, there ought to arise a disease of loss of voice. Perspiration is expected to come in three days. If it fails to come then, death will occur on the fourth day." As before, the main prognostic value of the pulse was in relation to impending death (or, if the pulse is favorable, recovery from the disease).
After the production of the Mai Jing, many different conceptions of pulse diagnosis arose and led to a great deal of confusion about interpreting what was being felt by the physician. Xu Dachun (1693-1771) produced a chapter on the Mai Jing in his book Yixue Yuanliu Lun (12), 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].
In other words, the classic texts of the Han Dynasty have the basic doctrines of importance, and they must all be studied in order for the Mai Jing to be fully meaningful. The digressions in the theory and practice of pulse diagnosis that were made later should, according to Xu, be ignored, because they introduce confusion rather than clarification. All the books mentioned by Xu in the above quote are now available in English translation (see: Some selected Chinese medical texts in translation), reflecting the common view that they are essential to the study of Chinese medical doctrines.

AIM AND METHOD OF PULSE DIAGNOSIS

The aim of pulse diagnosis, like the other methods of diagnosis, has always been to obtain useful information about what goes on inside the body, what has caused disease, what might be done to rectify the problem, and what are the chances of success. According to the Chinese understanding, the pulse can reveal whether a syndrome is of hot or cold nature, whether it is of excess or deficiency type, which of the humors (qi, moisture, blood) are affected, and which organ systems suffer from dysfunction. In order to make these determinations, the physician must feel the pulse under the proper conditions-following the established procedures-and must then translate the unique pulse that is felt into one or more of the categories of pulse form.
In his book reviewing pulse diagnosis (5), Bob Flaws emphasizes the importance of learning the basic pulse categories in order for pulse diagnosis to be conducted effectively. He says:
In my experience, the secret of Chinese pulse examination is exactly this: One cannot feel a pulse image unless one can consciously and accurately state the standard, textbook definition of that pulse image.
In support of this contention, he also quotes Manfred Porkert (6):
This, precisely, is the critical issue: there is no point in attempting practical training in pulse diagnosis unless all pertinent theory and, more important, the complete iconography [set of image categories] of the pulse has previously been absorbed intellectually.
Chinese medical texts do not describe what the practitioner experience is (or should be) during pulse diagnosis; this is left to be passed on from accomplished practitioner to student. In contrast, these Western scholars are trying to relate to their Western readers, in written form, the steps by which one can master the diagnostic method. The basic premise outlined by Flaws and Porkert-that one must master the categories first-appears to be supported in the Chinese literature by the almost universal practice of introducing pulse diagnosis by listing and describing the basic set of pulse categories.
The most standard inconography involves from 24-28 different pulse forms, depending on the recitation (sometimes a pulse type is subdivided into two; sometimes a complex pulse type is not included), though simplified sets are often given in less formal presentations. Despite the numerous descriptions of pulse forms in the lengthy Mai Jing, the practitioner is really being asked to become familiar with this modest sized and basic set of pulse categories, which were first outlined in the opening chapter of the Mai Jing. In the English language translation of the book, the description of these fundamental pulse categories take up just 3 pages out of 360.

PULSE CATEGORIES

In a recent article describing the standard pulse categories by terminology expert Xie Zhufan (7), 26 basic pulse types were outlined and given updated English language interpretations (two of the types have the same Chinese name but different descriptions). Table 1 presents these pulse categories.
In the table, the English translation term is given first; in a few cases, alternative English names are given for the same traditional category indicated by a single Chinese term (given in pinyin). The naming and interpretation of the pulse is taken directly from the article Selected terms in traditional Chinese medicine and their interpretations (7). The comments are added here by the current author, with reference also to information from the Dictionary of Traditional Chinese Medicine (8). The 7 pulses presented first (scattered, intermittent, swift, hollow, faint, surging, and hidden) are ones that may have little relevance to practice of traditional medicine in the modern setting. The other 19 pulses appear more likely to help the practitioner determine imbalances that relate to the selection of traditional style therapeutics (i.e., acupuncture points and individual herbs). Several of the pulses listed in the table represent pairs depicting yin/yang opposites, such as: floating vs. sinking (surface/interior); slow vs. rapid (cold/hot); weak vs. replete (deficiency/excess); and short vs. long (also indicating deficiency/excess).
There are three additional pulse types reported in the Dictionary (8): gemai (hard and hollow pulse), is large and taut yet feels hollow like touching the surface of a drum, indicating loss of blood and essence; it may also occur with hypertension; laomai (a forceful and taut pulse) is felt only by hard pressure, usually seen in cases with accumulation of cold pathogenic factors yielding formation of a firm mass; and damai (large pulse), is a high pulse wave that lifts the finger to a greater height then normal. Damai is either forceful (has a large mass behind it, indicating excess heat with damaged internal organ function) or weak (indicating little force, seen in cases of general debility, with "floating yang"). Many authors regard these pulses as composites of two or more basic pulses rather than unique pulse types.
Table 1: Pulse Categories in Translation.

Pulse Type Interpretation Comments
Scattered pulse
[sanmai]
An irregular pulse, hardly perceptible, occurring in critical cases showing exhaustion of qi. These are cases where the patient is critically ill, perhaps near death; such patients are normally hospitalized (or sent home to die) and their diagnosis is usually well-established. The pulse only tells that the patient is severely debilitated; it diffuses on light touch and is faint with heavy pressure.
Intermittent pulse
[daimai]
A slow pulse pausing at regular intervals, often occurring in exhaustion of zangfu organs, severe trauma, or being seized by terror. As with the scattered pulse, this pulse type is usually only seen in cases where the person is hospitalized or otherwise in an advanced disease stage. It is expected to occur, for example, with those having serious heart disease.
Swift pulse
[jimai]
A pulse feeling hasty and swift, 120-140 beats per minute, often occurring in severe acute febrile disease or consumptive conditions. This pulse is so rapid (twice the normal speed) that it is easily detected; the acute febrile disease involves an easily measured high temperature and is usually subject of pathogen testing. Consumptive conditions with such high pulse rates are generally under emergency medical care.
Hollow pulse
[koumai]
A pulse that feels floating, large, soft, and hollow, like a scallion stalk, occurring in massive loss of blood. Massive blood loss can easily be reported. This pulse is felt lightly at the superficial level and lightly at the deep level, but barely felt at the intermediate level. The light pulse is like the flexible scallion material, with a hollow center. It means that there is still some flow of qi at the vessel surface, but not much blood.
Faint pulse
[weimai]
A pulse feeling thready and soft, scarcely perceptible, showing extreme exhaustion. Extreme exhaustion is obvious to both the patient and the practitioner. The pulse, lacking substance, volume, and strength, simply reveals the exhaustion of the body essences. It is weaker than the thready (faint) pulse.
Surging pulse
[hongmai]
A pulse beating like dashing waves with forceful rising and gradual decline, indicating excessive heat. Excess heat syndromes are rarely difficult to detect, so this pulse type adds little information. The force of the pulse indicates that the condition is pathologically excessive, the gradual decline shows that the syndrome is primarily one of heat (qi excess) rather than fluid excess. The pulse is sometimes described as a "full pulse" indicating the excess condition.
Hidden pulse
[fumai]
A pulse that can only be felt by pressing to the bone, located even deeper than the sinking pulse, often appearing in syncope or severe pain. This pulse is quite extreme, in that one can barely detect it except by applying deep pressure; it gives the sense that the pulse is hidden in the muscles. If there is little musculature, it is as if it is resting on the surface of the bone. The conditions for which it is typical, syncome (fainting) and severe pain, can easily be determined without taking the pulse.
Knotted pulse
[jiemai]
A slow pulse pausing at irregular intervals, often occurring in stagnation of qi and blood. Qi and blood stasis represents a traditional diagnostic category that does not have a direct correlation with modern diagnostics. In this pulse, the irregularity and slowness is due to obstruction.
Hurried pulse
[cumai]
A rapid pulse with irregular intermittence, often due to excessive heat with stagnation of qi and blood, or retention of phlegm or undigested food. This is the excess version of the knotted pulse. It is sometimes called the "running" or "abrupt" pulse. The rapidity indicates heat and the irregularity indicates the blockage caused by stagnation and/or accumulation.
Long pulse
[changmai]
A pulse with lengthy extent and prolonged stroke. A long pulse with moderate tension may be found in normal persons, but a long and stringy pulse indicates excess of yang, especially liver yang. Particularly in young people, the pulse is felt rather easily across all three finger positions, as is characteristic of the long pulse. The prolonged stroke shows that the vessels are both strong and flexible. A stringy quality indicates a certain level of tension, that corresponds with a liver syndrome. In cases of acute disease, a long pulse will occur when there is a strong confrontation between the body's resistance and the pathogenic factor.
Short pulse
[duanmai]
A pulse with short extent. A short and forceful pulse is often found in qi stagnation and a short and weak pulse implies consumption of qi. The short pulse seems to deteriorate from the central pulse position towards the two adjacent pulse positions. It strikes the middle finger sharply and leaves quickly. On the one hand, this can represent contraction of the qi, as in liver qi stagnation, or it can represent deficiency of the qi.
Fine pulse
[ximai]
or
Thready pulse
[ximai]
A pulse felt like a fine thread, but always distinctly perceptible, indicating deficiency of qi and blood or other deficiency states. Although the deficiency can be easily detected by other means, some patients can show an artificially robust exterior appearance, while having notable deficiency. Essence deficiency, the result of chronic illness, can give rise to this pulse type.
Hesitant pulse
[semai]
or
Uneven pulse
[semai]
or
Choppy pulse
[semai]
A pulse coming and going choppily with small, fine, slow, joggling tempo like scraping bamboo with a knife, indicating sluggish blood circulation due to deficiency of blood or stagnation of qi and blood. This has a more irregular pattern than the knotted pulse that also shows stagnation of qi and blood. The severity of the blood disorder is greater. As the knife scrapes across the bamboo, it vibrates and irregularly moves forward, yielding a choppy sensation with brief hesitations or interruptions in movement.
Slippery pulse
[huamai]
A pulse like beads rolling on a plate, found in patients with phlegm-damp or food stagnation, and also in normal persons. A slippery and rapid pulse may indicate pregnancy. While use of the pulse to indicate pregnancy is no longer of value (as more reliable tests are readily available), and while this pulse, like the long pulse is often normal (occurring especially in persons who are somewhat heavy), it is a good confirmation of a diagnosis of phlegm-damp accumulation. It is sometimes referred to as a "smooth pulse."
Relaxed pulse
[huanmai]
or
Loose pulse
[huanmai]
A pulse with diminished tension, occurring in dampness or insufficiency of the spleen. The pulse has a softness or looseness that is due to the weakness of the qi and the obstructing effect of dampness. The dampness differs from phlegm-damp in having no solidity.
Moderate pulse
[huanmai]
A pulse with even rhythm and moderate tension, indicating a normal condition. This is similar to the loose pulse, above (and the Chinese name is the same), except that it has a better tension, showing that the qi is adequate. As a normal pulse, it indicates that the disease condition being treated is localized and has not disturbed or been caused by disturbance of the viscera.
Tense pulse
[jinmai]
or
Tight pulse
[jinmai]
A pulse felt like a tightly stretched cord, indicating cold or pain. This is similar to the wiry pulse, but not as long. While pain can be easily reported, a cold syndrome is sometimes disguised by localized heat symptoms; this pulse can indicate either exterior or interior chill.
Stringy pulse
[xianmai]
or
Wiry pulse
[xianmai]
A pulse that feels straight and long, like a musical instrument string, usually occurring in liver and gallbladder disorders or severe pain. This is similar to the tense pulse, but longer and more tremulous. While severe pain can be easily reported, the wiry pulse confirms the liver and/or gallbladder as the focal point of the internal disharmony.
Replete pulse
[shimai]
or
Forceful pulse
[shimai]
A pulse felt vigorously and forcefully on both light and heavy pressure, implying excessiveness. This pulse gives relatively little information other than that the condition is one of excess; one must further determine the nature of the excess in order to select a therapeutic strategy. This pulse, however, generally rejects the use of tonification strategies, as it indicates that the body resistance is undamaged.
Weak pulse
[ruomai]
A pulse feeling deep and soft, usually due to deficiency of qi and blood. This pulse is similar to the fine pulse, but has a softer quality. Usually, this indicates a weakness of the spleen qi, leading to deficiency of both qi and blood. In the system of pulse taking, it serves as the opposite of the replete pulse.
Soggy pulse
[rumai]
A superficial, thin, and soft pulse which can be felt on light touch like a thread floating on water, but grows faint on hard pressuring, indicating deficiency conditions or damp retention. This pulse is similar to the fine and weak pulses. The thready pulse sensation felt on light touch gives the impression of being easily moved, as if floating on water; hence, it tends to indicate spleen-qi deficiency with accumulation of dampness. It is sometimes referred to as the "soft pulse."
Feeble pulse
[xumai]
A pulse feeling feeble and void, indicating deficiency of qi and blood or impairment of body fluid. This pulse is similar to the weak, fine, and faint pulses. It occurs when the deficiency of blood is more severe than in the case of weak and fine pulses, but not so deficient as with the faint pulse.
Rapid pulse
[shoumai]
A pulse with increased frequency (more than 90 beats per minute), usually indicating the presence of heat. The rapid pulse is quite a bit more rapid than a normal pulse, and usually occurs only when there is a serious illness and mainly when there is a fever. The pulse can become rapid from activity prior to pulse taking.
Slow pulse
[chimai]
A pulse with reduced frequency (less than 60 beats per minute), usually indicating endogenous cold. A slow pulse may also indicate a person at rest who normally has a high level of physical activity, so must be interpreted in light of other diagnostic information.
Sinking pulse
[chenmai]
A pulse that can only be felt by pressing hard, usually indicating that the illness is located deep in the interior of the body. The circulation of qi and blood from the internal viscera to the surface is weak; it is usually confined to the interior as part of the body's attempt to deal with a serious disorder threatening the viscera. Sometimes referred to as the deep pulse.
Floating pulse
[fumai]
A pulse that is palpable by light touch and grows faint on hard pressure, usually indicating that the illness is in the exterior portion of the body. The circulation of qi and blood is focused in the body's surface to deal with an external pathogenic agent. The internal circulation is temporarily sacrificed to assure that the pathogen is eliminated before it can enter more deeply and cause serious problems at the visceral level. Debilitated patients may show a floating pulse that is feeble, indicating the inability to retain the qi and yang in the interior due to the deficiency of the vital organs.

Gao De, a diagnosis specialist at the Academy of Traditional Chinese Medicine, cautioned that pulse taking has become obscured by a multiplication of pulse categories (13). He wrote:
The types of pulses that have been listed are too numerous and great disparity exists in the ways in which they have been recorded. Beginners often find them confusing. There are two major reasons for such confusion:
  1. The difference between some categories is not so sharp, such as that between overflowing and large, thready and small, rapid and fast (hurried), and deep and hidden.
  2. Additional nomenclature is given to the multi-feature pulse conditions. For example, the leathery pulse is the combination of hollow and wiry; weak-superficial is another name for both weak and superficial; firm (or hard) means the combination of deep, full, wiry, and long; etc.
Single-feature pulse conditions are already numerous enough and the additional nomenclature adds even more names which have little clinical significance but add to the difficulties for beginners. Therefore, it is advisable to simplify the categories of pulse conditions by omitting the names of those confusing multi-feature pulse conditions. If more than one feature has to be described, the doctor can simply put those single features together. With this in mind, I would recommend the following list of simplified pulse conditions:
superficial vs. deep;
slow vs. rapid;
empty vs. full;
overflowing vs. thready; and
minute, rolling, choppy, wiry, scattered, hasty, knotted, and intermittent.
Mastery of these 16 basic single-feature pulse conditions, together with their possible combinations and their indications, is sufficient to meet the needs in clinical differentiation of syndromes.
In the text Chinese Acupuncture and Moxibustion (15), there is a listing of 17 pulses to know, all of which are said to represent the abnormal conditions. The same paired pulses as listed above by Gao De are included, but the list of additional pulses varies slightly. Compared to the list of 28 pulses in Table 1, the categories that have been disregarded in order to yield the shorter list of abnormal pulses include several of those that are indicating severe deficiency diseases (scattered, hollow, faint) and those that indicate a relatively normal condition (long, relaxed, moderate). In Essentials of Chinese Acupuncture (20), 12 basic pulses are listed, with the same paired pulses given above, plus the wiry pulse and three of the irregular pulses.
Similarly, in the book Chinese Herbal Science (17) by Hong-yen Hsu, the pulses of importance are limited in number. The author states: "In traditional Chinese pulse diagnosis, there are 28 qualities, but they are grouping into eight types according to the nature and associated symptoms. The most important qualities for the physician to be able to differentiation are floating, sinking, slow, and fast." The other four pulse qualities listed in this text are: weak, solid, slippery, and full. The same author gave a more detailed listing of pulses in a presentation on Chinese diagnostics (18), with 7 types of floating pulses, 3 types of sinking pulses, 5 types of late pulses, 5 types of fast pulses, 6 types of weak pulses, 3 types of solid pulses, and 11 types of dying pulses. Thus, 40 pulse types were depicted, but they fell into just a few basic categories.
The general implication of the literature on pulse is that there are about two dozen pulse types to be learned in detail, but that there are only a few of them (sometimes grouping similar pulses together) that are critical for the everyday utilization of this diagnostic technique used in combination with other methods of diagnosis. Therefore, pulse diagnosis should be within the grasp of all practitioners of traditional Chinese medicine. Those who have limited training and abilities must learn about 8-17 fundamental pulse types; those who wish to make greater use of this technique must be able to distinguish more subtle variations, but the number of different pulses to learn is still limited.

TRADITIONAL PULSE TAKING METHODS

A variety of sites for pulse taking have been mentioned in the traditional literature. For example, in the Neijing Suwen, it is mentioned that the yang pulses can be felt at the carotid artery (next to the Adam's apple on the neck), while the yin pulses can be felt at the radial artery (above the wrist). Under healthy circumstances these pulses should be the same, but they differ with disease. Feeling the pulse at more than one site is said to improve the diagnosis. Other pulse taking methods include using the head and upper and lower limbs, and use of different pulse locations at arteries under certain acupuncture points to assess individual organs (e.g, at taiyang, ermen, dicang, daying, shenmen, hegu, wuli, taichong, qimen, chongyang, and taixi).
Despite the availability of more than one site for pulse taking, standard Chinese medical diagnosis almost always is limited to the wrist pulse. It is felt by placing three fingers at the radial artery (see Figures 1 & 2), testing each arm one at a time. The classic Chinese pattern of pulse taking is based on touching the wrist with three levels of pressure: superficial palpation (almost no pressure, to feel the bounding of the pulse up to the skin surface); intermediate palpation (light pressure, to feel the basic pulse form); and deep palpation (somewhat heavy pressure, to feel how the pulse is able to emerge from the physical constraint). In addition, the changes in pulse feeling as one moves from less to more pressure, and again from more to less pressure, can also give some information about the resilience of the pulse. In essence, there are nine pulse takings on each wrist: one for each of the three pulse taking fingers at each of the three levels of pressure. However, the system of pulse taking can be divided into two parts:
  • The general sensation of the pulse at the two wrists overall: instead of distinguishing each pulse position (cun, guan, chi), the quality of the pulse is categorized generally, as felt under the three fingers. In this case, there are just three pulse readings at each wrist, with superficial, intermediate, and deep pressure. The results of this type of pulse reading are then categorized as in Table 1, with combinations of two (or infrequently more than two) pulse categories being possible.
  • Feeling the pulse at each of the individual positions on the wrists, to assess the condition of each of the internal organs. The association of individual pulse positions with internal organs has changed over time and varies from one traditional system to another (illustrating a lack of consistency in interpretation). The current understanding is that the left wrist presents information for the heart, liver, and kidney yin, while the right wrist presents information for the lung, spleen, and kidney yang. This classification is consistent with the five element system that depicts five basic viscera; the kidney is subdivided to make the sixth. However, one can alternatively incorporate the pericardium/triple burner system in place of the kidney yang pulse.
The interpretation of which pulse position corresponds to which organ has changed over time; the assignments commonly relied upon today are attributed to Li Shizhen (1518-1593), who is most famous as the author of the Bencao Gangmu. He wrote Binhu Maixue (The Pulse Studies of Binhu), in which the pulse taking method was elaborated, for which 27 categories of pulse were listed.
The various outcomes of the pulse diagnostics are outlined succinctly and in table form in Ted Kaptchuk's book The Web that Has No Weaver (14). Here is an example for one pulse type, the choppy pulse:
  • Combination pulses: choppy and wiry indicates constraining liver qi, congealed blood; choppy and frail indicates qi exhausted; choppy and minute indicates deficient blood and deficient yang; choppy and thin indicates dried fluids.
  • Pulses by position: first position pulse being choppy indicates deficient heart qi and chest pain; if only on the left side, heart pain and heart palpitations; if on the right side, deficient lung qi, cough with foamy sputum; second position pulse being choppy indicates deficient spleen qi and deficient stomach qi, painful, distended flanks; if just the left side, it means deficient liver blood; on the right side it means weak spleen and inability to eat; third position pulse being choppy indicates essence and blood are injured; constipation or dribbling urine, or bleeding from the anus; if just on the left side, it means lower back is weak and sore; if just on the right side, it means a weak mingmen fire and/or essence injury.

FACTORS TO CONSIDER BEFORE AND DURING PULSE EXAMINATION

In the well-known study guide, Acupuncture: A Comprehensive Text (15), it is said that: "Diagnosis by pulse is a subtle art and, even more than other diagnostic procedures, requires a tremendous amount of attentiveness and experience in order to acquire the sensitivity necessary to do it well." Proper pulse taking involves accounting for a number of factors that can affect the ability to feel the pulse and interpret it properly. These factors include several that affect the traditional practitioner in China, but some that present new problems for the modern practitioner:
  1. The patient must be relaxed and have not undertaken any vigorous activity for some time prior to the pulse taking. It is generally thought that the pulse should be felt in the morning to get the best reading. Unfortunately, most modern patients rush through traffic to arrive at an appointment that takes place later in the day, after many activities have influenced the quality of the pulse.
  2. The patient's arm, wrist, and hand must be relaxed, with the hand supported on a small pillow or other object; the hand is below the heart, at about the location of the navel as the person sits. The physician is calm and able to concentrate; the physician's hand that is performing the diagnosis is also in a relaxed position. As described in Chinese Acupuncture and Moxibustion: "The three fingers are slightly flexed, presenting the shape of an arch. The finger tips are kept on the same horizontal level." In many rushed modern practices, the pulse is taken whenever it seems convenient, with the position of patient and practitioner often being less than ideal, thus distorting the pulse reading.
  3. The placement of the physician's fingers are at the cun ("inch"), guan ("bar"), and chi ("cubit") positions. The middle finger is placed over the eminent head of the radius and the other two fingers are placed adjacent to that one, but usually not touching one another or just barely touching (the separation of fingers depends on the size of the patient, being greater in those who are tall and have long arms, and less in patients who are relatively smaller), along the artery. The wide range of body types that are encountered in the modern practice make it more difficult to place the fingers properly to feel the pulse.
  4. The physician, through training and experience, applies the appropriate amount of pressure. Gao De, in his review of pulse diagnosis, commented: "Doctors exerting different forces in pulse-taking get different conclusions regarding both the depth at which the pulse beating is felt and the strength of the pulse; hence, also different conclusions of the overall pulse condition arise." Having applied pressure properly, the doctor must be familiar with the different categories of pulse conditions so as to be able to classify that which is detected into the category that most closely describes what is felt. As described above, this is the essential feature of pulse taking, one that Western writers must emphasize because it is not necessarily taught that way in the standard training programs.
  5. Adequate duration of pulse diagnosis is allowed to assure that the pulse description holds true over many pulsations, and that both arms are checked in order to give a full evaluation. Often, there is not enough time available to perform a complete pulse diagnosis. As stated in Acupuncture: A Comprehensive Text: "The doctor must refrain from quick pulse-taking in a hurried frame of mind. If this precaution is not observed, the resulting pulse readings will be misleading."
  6. One must take into account the season. Although there is great detail in describing seasonal influences on the pulse in traditional texts, a most general depiction is: the spring pulse is slightly taut (bowstring); the summer pulse is slightly full and surging; the autumn pulse somewhat floating and fine or soft; and the winter pulse somewhat sinking and slippery or hard. If the pulse type is consistent with the season, that indicates a normal condition, while if it differs markedly, it suggests a pathological condition. There is some question, however, as to how this seasonal influence might be modified by modern living habits, including rising and going to bed out of synch with the sunrise and sunset, use of central heating and air conditioning, and eating foods out of season.
  7. One must take into account patient characteristics that influence the pulse. According to Acupuncture: A Comprehensive Text:
    In a healthy person, the front position tends to be floating, while the rear position is usually submerged....Athletes often have a slow pulse, young children have quick pulses. Fat people have deep pulses, while thin people have pulses with a tendency to be bigger than normal. Woman's pulses are usually softer and slightly quicker than men's. Also, women's right pulses are usually stronger than their left, while the opposite is true of men.
    Gao De commented:
    A doctor must be aware of the fact that as numerous changes can take place within a man's body under natural physical condition, so can variations of normal pulse condition. Such variations will be within certain limits and still bear the basic features of the normal pulse condition. Theoretically speaking, the demarcation line between variation of normal pulse condition and diseased pulse condition is not clear cut....Diseases pulse conditions: 1) are attended with symptoms and signs corresponding to the pulse conditions; 2. cannot be explained by the external factors that may affect pulse condition [e.g., age, sex, physical constitution, season, etc.]; and 3) remain abnormal after the external factors seemingly affecting the pulse are removed unless effective treatment is applied.
    In addition to these factors based on traditional and natural considerations, one must take into account new factors that may influence the pulse, such as use of drugs, including nicotine products, pharmaceutical drugs, and illegal drugs.
The numerous factors to be taken into consideration and the associated difficulties in interpretation mean that pulse taking in the modern setting is rarely as informative as it is depicted in the historical texts. Nonetheless, despite the problems that can arise, modern pulse taking can usually reveal most of the 24-28 basic categories. The pulse taking may not as easily reveal the more numerous indications depicted in the Mai Jing or in some other texts. Of course, a practitioner who specializes in pulse diagnosis and spends years studying the theory and categories and carefully takes the pulse of many hundreds of patients could still master the system, but the impetus to do so seems muted: there are too many interferences of modern society that make the pulse less informative and there is plenty of other diagnostic information available. Yet, those involved with modern Chinese medicine should not dismiss the pulse simply because a variety of factors need to be taken into account; it becomes necessary to become aware of these factors and give adequate time and attention so as to limit their potential for confusing the interpretation.

PULSE AS AN AID TO OTHER DIAGNOSTICS

During the development of Chinese medicine, there appears to have arisen, from time to time, an understanding that a well-trained physician was able to make a diagnosis almost entirely by pulse taking, while asking virtually no questions of the patient. As a result, pulse analysis sometimes took on a certain mystical aura and was a major focus of doctor-patient interaction. Aside from the complaints about this in the historical literature as already cited, Gao De mentions it as a continuing problem in the practice of Chinese medicine up to the modern era: "Some even applied pulse diagnosis in clinical practice in a completely isolated way, disregarding the other three, namely inspection, smelling, and asking, thus having led the development of pulse diagnosis astray." In Acupuncture: A Comprehensive Text, the authors still allude to the possibility of using the pulse as a sole method of diagnosis by saying: "While most Chinese doctors would agree that the pulse is best used in conjunction with the other diagnostic methods, doctors well-skilled in pulse diagnosis can discover an enormous amount of information about their patients by this method alone."
The utility of pulse diagnosis may be more properly viewed as belonging to the realm of confirming a diagnosis attained by other means, including modern medical testing, or implying that something is missing from the diagnosis when the pulse does not agree, setting off a series of questions or investigations for additional information. This application of pulse as confirmation is one that Bob Flaws has argued against having modern practitioners rely on, even though he observed it as a common situation in China. He wrote in the introduction to his book on pulse:
This Western ambivalence toward and pervasive lack of mastery of the pulse examination is, I believe, exacerbated by a somewhat similar attitude towards pulse examination current in the People's Republic of China at least in the 1980's. 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....I never had a teacher tell me a pulse was anything other than wiry, slippery, fast, slow, floating, deep, or fine...it seems that many modern Chinese TCM practitioners relegate pulse examination to a minor, confirmatory role....I believe that mastery of pulse examination is vitally important to making a correct TCM pattern discrimination. And, I believe the pulse examination is, perhaps, even more important to Western practitioners than for our Chinese counterparts.
Indeed, the set of pulses that Flaws mentioned hearing repeatedly in China is the most basic set that must be learned and is similar to what was described above by several authors as the key categories. He has relayed a group of opposing pairs that help assure that the treatment is consistent with the underlying pattern and unlikely to cause adverse effects by reinforcing an imbalance. In the opening chapter of The Heart Transmission of Medicine (9), by the famous 19th Century physician Liu Yiren, he states: "Four kinds of pulse are the key criteria in examination: the floating, deep, slow, and rapid. The floating and deep can be discerned by light and heavy pressure of the fingers. The slow and rapid may become the moderate and the racing. This can be identified by respirations [i.e., counting the number of pulses per respiration]." While Liu then goes on to give a somewhat more complex system of diagnosis, with attention focused on the three pulse positions of each radial artery to discover ailments of the major internal organs, even that is greatly simplified compared to what is found in the Mai Jing. Overall, Liu aims his comments on pulse at helping the practitioner to integrate pulse information with other diagnostic methods, mainly rational inquiry.
In his book, Flaws goes on to argue that the importance of the pulse in modern practice lies with the complexity of chronic conditions suffered by many patients who turn to acupuncture in the West. The idea is that these patients typically present a picture that is difficult to sort out, and that the pulse can provide information that resolves the dilemma. I would argue, contrarily, that this complexity of the patients makes pulse diagnosis more difficult to rely on, rather than more valuable. One can come to this view by reading the indications of the pulses in the Mai Jing, in which the interpretations are very succinct and focused: this pulse is common in the spring, this pulse means taiyin disease, this pulse means a fever, etc. By contrast, the complexity of modern patients, especially those who are older and suffer from numerous diseases, means that within one individual there is a complex of deficiencies and excesses, of internal and surface disorders, of stagnation and looseness, and influences of drugs, surgery, and daily habits that don't fit any traditional pattern. The resulting pulse is more difficult to analyze and less informative.
According to Chinese Acupuncture and Moxibustion: "As the process of disease is complex, the abnormal pulses do not often appear in their pure form, the combination of two pulses or more is often present. The condition of a number of pulses present at the same time is called complicated pulse. The indication of a complicated pulse is the combination of indications of each single pulse." The complexity depicted in this textbook statement is applied to ordinary cases that have occurred throughout medical history in China. Today, the influence of surgery, powerful modern drugs that are taken chronically, and extreme variability in life style means that the complexity can be even greater. Thus, the physician who wishes to rely on the pulse under such circumstances must become familiar not only with several basic pulse types, but must develop the ability to detect and interpret very complex pulse forms, teasing out multiple pulse types within the sensation under the fingers. Some physicians have argued, instead, that the pulse diagnosis should have a relatively limited role. Xu Dachun commented: "In my own view, the doctrine of the pulse only includes examining whether a patient's qi and blood are present abundantly or insufficiently, and through which meridian or through which organ cold, heat, or other evil influences flow. This has to be compared to the patient's symptoms...."
Clearly, the role of pulse within the full framework of diagnosis will remain an area of some contention. Advocates of pulse diagnosis having a central role can point to the large amount of information contained in the pulse that can lead one to an improved understanding of the disease process affecting the patient; critics will point to the wide variation in results of pulse taking, being dependent on so many factors, and will emphasize, instead, the essential role of examining the medical history and current symptoms as revealed by inquiry. However, few proponents of pulse diagnosis today would suggest downgrading the other diagnostic techniques and few critics of pulse diagnosis propose eliminating it. So, a certain level of consensus arises.

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.
While patients in China have come to rely on the traditional medical practitioners to simply carry out their diagnosis in silence and prescribe a therapy to be taken without question, modern patients in the West prefer to talk about their diseases. They usually demand to have explanations given for every step of diagnosis and for every factor that goes into a determination of a therapy. In fact, one of the main complaints raised by Westerners who visit Chinese immigrant doctors is that there is no significant discussion of their case, even when language is not a major barrier. For the Western patient, the focus is shifted towards the concerns that can be verbally expressed and away from the more mysterious diagnosis attained by pulse taking.
The complex condition of many modern patients may require one to rely heavily on modern medical diagnostics as a primary resource, making it the essential fifth diagnostic method for the practitioner of Chinese medicine. This is not a matter of the traditional practitioner deciding that this is the desired route, but a reflection of the extent to which modern lifestyle and modern medicine imposes itself on people who might have an interest in a traditional and natural approach. It is not uncommon for a patient to come to a traditional practitioner with Western medical test results and diagnosis and to want to know what is going to be done specifically about this situation as defined by those tests. A response that the therapy will rectify qi and blood and resolve the dysfunction of an organ system not mentioned in the modern test results may prove unsatisfying to the patient. Yet, it is precisely in this area-of measuring traditional-style indicators-that pulse diagnosis is employed in order to make corrections.
The question arises: does the old system of pulse diagnosis still have a value to practitioners of traditional medicine given the wealth of information derived from modern tests? In particular, in Western countries where extensive testing is readily available, can the traditional practitioner either ignore the information from those tests in favor of traditional style diagnostic methods or even gain any additional information from traditional pulse diagnosis once the modern tests have been conducted? This is answered in favor of retaining pulse diagnosis because of the nature of the therapeutics to be employed by the traditional practitioner. For the most part, the indications and applications of acupuncture and herbal therapies are not described in terms that correlate with the results of modern medical tests. They are described in terms of effects on qi and blood, hot and cold, and the zangfu organs. Even with the more limited use of pulse diagnosis that has been advocated by many authorities-relying on only about half of the basic pulse categories to get the fundamental differentiation-the results of the pulse taking can be applied to determining the therapeutic strategy. Regardless of whether one considers pulse taking a central and key part of a traditional style diagnosis or relegates it to a more minor confirmatory role, it still belongs to the modern practice of traditional medicine and requires the practitioner to be familiar with the major pulse categories.

ALTERED USE OF PULSE DIAGNOSIS

Many acupuncturists trained in the West have pursued a type of pulse diagnosis that is not described in the traditional Chinese literature. While the original Chinese pulse taking is utilized to arrive at both a diagnosis and at prognosis, many Western acupuncturists utilize a pulse analysis to determine whether or not they have properly inserted the needles. This is done by feeling the pulse after the needles have been inserted, either immediately or after they have been in place for several minutes. It is claimed that a properly conducted treatment yields correction of the pulse to a normal, or more normal, condition which is detected at the time of the treatment. Presumably, what is being detected is the improvement in the flow of qi and blood under the influence of the acupuncture needles.
The source of this method and application of pulse diagnosis remains unclear, but it was described by He Honlao, a Chinese acupuncturist working in the U.S., in an article published in 1987 (10). He stated: "By clinical practice, I noticed the fact: There are changes in the pulse condition after acupuncture." In explaining the observation, he conjectured that this use of the pulse analysis was a means of detecting the "arrival of qi" with acupuncture (see: Getting qi). From the modern perspective, he referred to research carried out in China during the 1950's that indicated a short term contraction followed by a longer-term expansion (dilation) of the blood vessels as a response to acupuncture therapy. In his article, he evaluated the pulse changes in 400 patients who had a string-like pulse (in which he included wiry, tense, solid, and firm pulse types), which indicated a tension syndrome. Accordingly, if acupuncture successfully dilates and relaxes the vessels, the pulse will change so that it is not as string-like (or taut). He claimed that in those patients whose pulse changed (softened immediately, as well as eventually, after several treatments) with acupuncture, nearly all had their symptoms relieved; of those whose pulse did not change with acupuncture, or those that showed immediate changes that promptly reverted after treatment, the symptoms were usually not relieved (in 3 out of 4 cases).
Dr. He indicated that, ideally, the pulse would return to normal or markedly calm down after the needle insertion and this improved pulse condition would continue until the needle was withdrawn; the pulse would stay calm at least for a time afterward. In some cases, the pulse returned to its former condition immediately after needle removal; and in other cases, the pulse was not altered by acupuncture at all. In rare cases, the pulse would actually become stronger, or more tense. He also noted that over several treatments the majority of patients had their pulse gradually becoming more normal, while others took several treatments before this response developed at all; some patients continually returned to pretreatment pulse conditions after every acupuncture session.
In the introduction to the article, Dr. He describes his observation as a "discovery," therefore not something belonging to the Chinese tradition and not something that he was aware was being relied upon by other acupuncturists at the time. In his discussion, he cites one statement from the Jingui Yaolue that he believes supports his contention and method. The quotation, taken here from a published translation (11), states: "If the pulse is minute and harsh on the cun site and thin and tense on the guan site, it is appropriate to activate yang qi by acupuncture in order to soften the harshness and to relax the tenseness, thus bringing about recovery." Dr. He has assumed, perhaps correctly, that the softening and relaxing effect described in this text applies to the immediate change in the described pulse, as opposed to merely suggesting a change in the patient's overall tense condition. It is difficult to know what was meant in the ancient text, but the lack of further reference to the spontaneous pulse changes in the traditional Chinese medical literature suggests that this was not a major means of utilizing pulse evaluation.
It would not be surprising that acupuncture would alter the pulse sensation detected in some or even most individuals (see: An introduction to acupuncture and how it works). More research would be needed to determine how widespread this phenomena is, since Dr. He described only one very broad type of pulse and did not indicate anything about the nature of the treatments given (for example, whether needles were inserted proximate to the artery on which the pulse was measured). Such research might help to confirm or deny whether such pulse changes were truly valuable indicators of the success of a long-term treatment. Certainly, this method has a potential for good use in the modern setting where some people are asked to pursue acupuncture for many sessions over several weeks in order to determine if it is ultimately going to alleviate their condition. The immediate pulse response or lack thereof, if truly informative as Dr. He suggests, might help the practitioner and patient determine the likelihood of success after only a couple of sessions.
While this type of diagnosis may be valuable for its primary purpose as a means of confirming the desired reaction from acupuncture therapy, it is not the same as the pulse taking method that is used for basic diagnosis and should not be assumed to replace the traditional style and application of pulse diagnosis. Rather, it can be regarded as an added technique which may be of value for the modern practitioner.

ATTEMPTS TO MAKE PULSE DIAGNOSIS OBJECTIVE

One of the serious objections to reliance on pulse diagnosis is that the pulse form determined by a practitioner is very subjective. It relies on how the physician places fingers on the wrist, what pressure is applied, and how the physician's mind interprets the sensations. Several physicians feeling the pulse of the same patient consecutively may report differing pulses. In China, researchers hoped to illustrate the value of the wrist pulses as a diagnostic method and also to aid in standardizing their measurement by devising modern devices for getting an objective pulse form. The result of such a measurement, using devices to detect the pulse, is a printed version, called a sphygmogram.
In his article on pulse diagnosis, Gao De said that: "The most pressing need in our study on pulse taking diagnosis is to devise an instrument to assist doctors when they take pulse with their fingers so as to get an objective judgment of the patient's pulse condition." Such instruments were soon developed. At a 1987 traditional medicine conference in Shanghai (19), several doctors reported on methods of measuring the pulse by pulse detecting devices. They further proposed that such measuring devices could assist students of Chinese medicine in learning pulse diagnosis, since the accuracy of the students' pulse determinations could be verified by the sphygmogram. Indeed, one author described the use of a device to reproduce the measured pulse which could then transmit the pulse to the student. By this means, the different kinds of pulses, having been prerecorded and stored in a computer, could be imitated for the student to experience so that each of the pulse categories could be learned. Just as simulators are used today to train pilots learning to fly, these pulse simulations are deemed a means of training practitioners to perform the diagnosis, which is to be mastered with actual pulse feeling after learning the basics. Fei Zhaofu and his colleagues at the Shanghai College of Traditional Chinese Medicine commented about the pulse-imitating devices used for this purpose:
Imitating the pulse actually means that the abstract descriptions and images [of the traditional system] are changed to specific figures signifying digital senses directly felt and stored. During the process of investigation, the device has been affirmed by many veteran practitioners of TCM, with repeated correction for improvement leading to its final approval by TCM circles. The device is therefore considered to have effectively inherited TCM sphygmology theory and preserved the pulse feeling experience of TCM. Medical personnel may use it to gradually promote the standardization of pulse diagnosis....

RECENT INVESTIGATIONS OF PULSE

Chinese researchers have pursued the question of how often certain pulse types are found, particularly with frequently occurring serious diseases, such as cancer and hepatitis. For example, it was reported by researchers working at several institutions in mainland China that (21):
Studies indicate that wiry, slippery, and rapid pulse, or simply wiry and rapid pulse, often denotes exacerbation of the illness [cancer]. When slippery and rapid pulse, wiry and rapid pulse, or weak and rapid pulse appears post-operatively in patients with carcinoma, one should seriously consider the possibility of an incomplete operation. Owing to difficulty in inspection of tongue features of patients with oral or facial neoplasms, physicians often resort to pulse-taking to follow-up the patient, and it is found that the chi pulse is weakened in 50%, and absent in 25% of the patients, which is statistically significant in comparison with the pulse of normal subjects.
In a study of advanced hepatitis patients with cirrhosis or liver cancer carried out in Taiwan, it was reported that most of the patients had a weak pulse on the left wrist at the cun and chi positions, compared to normal subjects (22).
In a broad evaluation conducted in Hong Kong, it was reported that specific pulse categories are more commonly found with the initial stage of illness, versus more developed and advanced stages of an illness (23). The common pulses were:
  • Original pulses (initial stage of illness): floating, deep, slippery, uneven, long, short, taut, soft, large, small;
  • Changing pulses (serious disease develops): rapid, tense, slow, moderate, full, hollow, indistinct, thready, firm, weak; and
  • Very abnormal pulses (critical illness): tremulous, running, knotted, intermittent, tympanic, scattered, deep-sited, replete, feeble, no pulse.

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.

REFERENCES

  1. Academy of Traditional Chinese Medicine, Lectures on essentials of traditional Chinese medicine VI: Methods of diagnosis, Journal of Traditional Chinese Medicine 1982; 2(4) 321-328.
  2. Maoshing Ni, The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen with Commentary, 1995 Shambhala, Boston, MA.
  3. Hong-Yen Hsu and Peacher WG (eds.), Shang Han Lun: The Great Classic of Chinese Medicine, 1981 Oriental Healing Arts Institute, Long Beach, CA.
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      Pulse location diagram  
      Figure 1. Pulse positions on each wrist and their associated organs. 
      Practitioner taking pulse  
      Figure 2. TCM practitioner performing pulse diagnosis.