Wednesday, February 22, 2012

Review of Acupuncture Insurance Coverage in the USA

Insurance payments for acupuncture has been held up as the Holy Grail of the health of the AOM (Acupuncture and Oriental Medicine) profession since the mid-90s. While there are a number of insurance companies that provide this benefit, the actual dollars paid and definition of “medical necessity” vary widely.
What follows is a list of insurance companies and their policies regarding acupuncture payments, including copious links to their websites for more current information. Take particular note of the conditions that are covered. While acupuncture can be applied to almost anything, many insurance companies limit their coverage only to specific complaints such that acupuncture for very common complaints may not be covered, while dental pain or nausea due to pregnancy may be.
Insurance policies are very much in flux and generally a moving taget, this information may by obsolete, but at least it can give you a place to start your research. You can see how old this page is by scrolling to the bottom to note the “last updated” date.
Thanks go to Michael Jabbour with the ASNY and AAAOM for putting together this information.

AETNA

Aetna considers needle acupuncture (manual or electroacupuncture) medically necessary for any of the following indications [source]:
  • Chronic low back pain. (Maintenance treatment, where the patient’s symptoms are neither regressing or improving, is considered not medically necessary); or
  • Migraine headache; or
  • Nausea of pregnancy; or
  • Pain from osteoarthritis of the knee or hip (adjunctive therapy); or
  • Postoperative and chemotherapy-induced nausea and vomiting; or
  • Postoperative dental pain; or
  • Temporomandibular disorders (TMD)

ANTHEM

[source]
Description
Acupuncture is the practice of piercing specific areas of the body along peripheral nerves with needles with the goal of inducing analgesia, relieving pain, alleviating withdrawal symptoms of substance abusers, or treating various non-painful disorders. In acupuncture, the placement of needles into the body is dictated by the location of meridians, thought to mark patterns of energy flow throughout the human body. Acupuncture has 4 components the acupuncture needle(s), the target location defined by traditional Chinese medicine, the depth of insertion, and the stimulation of the inserted needle. Acupuncture may be performed with or without electrical stimulation.
Medically Necessary:
The use of acupuncture is considered medically necessary for treatment of nausea and vomiting associated with surgery, chemotherapy, or pregnancy provided the individual does not have either of the following:
  • Pacemaker; or
  • Automatic implantable cardioverter-defibrillator (AICD).
The use of acupuncture is considered medically necessary for treatment of painful chronic osteoarthritis of the knee or of the hip, if all of the following criteria are met:
  • Radiographic evidence of osteoarthritis; and Absence of ALL of the following:
    1. Other metabolic, inflammatory, or infectious causes of arthritis; and
    2. Pacemaker or AICD; and
    3. No plans for total joint replacement; and
    4. Pain significantly affecting daily activity and function.

ASHP (American Specialty Health Plans) & HEALTH NET

[sources: PDF1 PDF2]
Medically necessary services provided by a participating acupuncturist (or a non-participating acupuncturist, when emergency acupuncture services are provided or a referral is approved by ASHP) for the following injuries, illnesses, diseases, functional disorders or conditions, when determined medically necessary.
  • Initial examination, subsequent office visits, re-examination
  • Pain, including low back pain, post-operative pain and post-operative dental pain
  • Nausea, including adult post-operative nausea and vomiting, chemotherapy nausea and vomiting, and nausea of pregnancy
  • Carpal tunnel syndrome
  • Headaches
  • Menstrual cramps
  • Osteoarthritis
  • Stroke rehabilitation
  • Tennis elbow
  • Medically necessary X-rays and laboratory tests except as otherwise approved by ASHP’s Director of Acupuncture Services or Health Net.

Blue Cross Blue Shield

[source PDF]
Medical Policy Statement
Acupuncture is experimental/investigational for all indications.  While it may be considered safe and effective for treatment of nausea for selected patients, it has not been demonstrated to be any more effective than standard treatment.
Rationale
There is insufficient documentation in the medical literature to support the use of acupuncture as a treatment modality.  Patients in clinical trials using “sham” acupuncture needles and treatment had approximately the same result in relieving symptoms as true acupuncture needles and treatment.  There appears to be a large placebo effect in the use of acupuncture.  While certain studies have shown acupuncture to be effective in adult females for postoperative nausea control and chemotherapy related nausea and vomiting, it has not been established as having increased safety and effectiveness over standard therapies for this indication.
The introduction of acupuncture into the choice of treatment modalities readily available to the public is in its early stages.  Issues of training, licensure and reimbursement remain to be clarified.  There is sufficient evidence, however, of its potential value to conventional medicine to encourage further studies.
Medical Policy Position Summary (Non-clinical summary statement for customer use)
Acupuncture is the practice of inserting needles into the body to reduce pain or induce anesthesia.  More broadly, acupuncture is a family of procedures involving the stimulation of anatomical locations on or in the skin by a variety of techniques.  There are a number of different approaches to diagnosis and treatment in American acupuncture that incorporate medical traditions from China, Japan, Korea, and other countries. The most thoroughly studied mechanism of stimulation of acupuncture points employs penetration of the skin by thin, solid, metallic needles, which are manipulated manually or by electrical stimulation.
At the current time, acupuncture has not been proven to be any more effective in treating conditions such as headache, nausea and vomiting, pain, addictive behaviors, etc., than currently established medical therapies.  Therefore, acupuncture is considered experimental/investigational.
Inclusionary and Exclusionary Guidelines (Clinically based guidelines that may support individual consideration and pre-authorization decisions)
Acupuncture is not covered for any indication.

INDEPENDENT BLUE CROSS

[policies]

EXCELLUS BLUE CROSS BLUE SHIELD

[policies]

CIGNA

[source]
CIGNA covers acupuncture as medically necessary for any of the following indications:
  • nausea and vomiting associated with pregnancy
  • nausea and vomiting associated with chemotherapy
  • postoperative nausea and vomiting
  • postoperative dental pain
CIGNA covers acupuncture as an adjunct to standard conservative therapy for the treatment of ANY of the following CHRONIC painful conditions when other conservative methods of treatment have failed, there is limitation resulting in impaired activities of daily living, and there is reasonable expectation treatment will result in significant therapeutic improvement over a clearly defined period of time:
  • migraine or tension headache
  • osteoarthritic knee pain
  • neck pain
  • low back pain
CIGNA does not cover acupuncture when treatment is unlikely to result in sustained improvement or when there is no defined endpoint, including preventive, maintenance or supportive care, because it is considered not medically necessary.
CIGNA does not cover acupuncture for any other indication, because it is considered experimental, investigational or unproven.
CIGNA does not cover acupuncture point injection for ANY indication because it is considered experimental, investigational or unproven.

Health Network Solutions (HNS)

[policies]

LANDMARK

[Schedule of Benefits PDF]

MEDICARE and MEDICAID

As of May 2008: The Centers for Medicare and Medicaid Services (CMS) currently do not cover acupuncture under any condition and issued a national non-coverage determination for acupuncture in May 1980.  In April 2004, CMS issued non-coverage decisions for acupuncture for pain relief in fibromyalgia and osteoarthritis.  Citing study design flaws, CMS concluded there is no convincing evidence that acupuncture is useful in improving health outcomes.  Therefore, CMS affirmed acupuncture is not reasonable and necessary for pain relief in fibromyalgia or osteoarthritis.  This status is unchanged through 2006. Medicare does not cover acupuncture for any indication.

MUTUAL OF OMAHA

[source]
Medical Specialty opinions regarding the appropriateness and efficacy of acupuncture vary. Some State Insurance Laws mandate allowance of coverage of acupuncture by a provider licensed in acupuncture. Acupuncture is generally not covered by our group policies. If the policy language and /or Rider does provide coverage for acupuncture services, these should be provided by a licensed acupuncturist and follow the benefit limitations of the policy and the guidelines noted below.
Definition:
Acupuncture is the Chinese practice of piercing specific nerve areas with needles for pain relief or for induction of surgical anesthesia. Treatment should be provided only by a provider licensed or certified in acupuncture.
MEDICAL NECESSITY MAY BE INDICATED:
Failure of documented traditional conservative medical management with the use of NSAIDS/Steroids, Physical Therapy, Topical Agents, or Medical Pain Management for a minimal period of 3 months AND Treatment is Indicated for one of the following conditions:
  1. Rheumatoid Arthritis/Osteoarthritis
  2. Neuritis
  3. Intractable pain
  4. Bursitis
  5. Neuralgia
  6. Low Back Pain/Strain
  7. Migraines
  8. Chronic Headaches/Tension Headaches

NCHC: (North Carolina)

[policy PDF]

TRIAD HEALTH CARE

[source PDF]
  1. Statement of Policy
    1. The determination of medical necessity for the use of  acupuncture with and without application of electrical stimulation to the needles is always made on a case-by-case basis.
    2. The use of acupuncture (with or without the application of electrical stimulation) may be considered  medically necessary for  the treatment  of  pain or  other symptoms associated with disease, injury or surgery.
    3. The use of acupuncture (with or without the application of electrical stimulation to the needles) may be considered medically necessary for the treatment of the side effect of medication-induced nausea or nausea associated with pregnancy.
    4. The use of acupuncture (with or without the application of electrical stimulation) may be considered medically necessary for the treatment of  chemical dependencies  (including but not limited to nicotine, alcohol, narcotics, etc.).
    5. The use of acupuncture (with or without the application of electrical stimulation) may be considered  medically necessary for the treatment of psychological stress and generalized anxiety.
    6. Any treatment plan involving the use of acupuncture should ultimately result in a clinically meaningful reduction in the patient’s pain level,  an improvement in the targeted symptom/sign,  the reduction in the use of medication or medical services, and/or an improved ability to carry out their usual activities of daily living.  The use of POLICY LIBRARY:  MEDICAL Doc. Control #:  PRV.MQ.MP.077.001

Can You Wait 5 Minutes? A Guide to Quit Smoking

You didn’t become addicted to cigarettes overnight, and in my personal experience, it is best not to try to quit overnight.
In this article I hope to provide those who want to quit smoking with a method that I used to quit.
I found that breaking up this big job into a bunch of little ones made it much easier to do.
It worked for me, and after ten years, I would go so far as to say that the process has been permanent.
-Al Stone, L.Ac., DAOM
There are three phases to this protocol.
  1. Breaking the physical addiction,
  2. breaking the psychological addiction,
  3. and finally acupuncture.
I have found acupuncture to be wildly successful. However unless you’re really at that point where you’re ready to put down your cigarettes for good, acupuncture’s benefit is limited. Acupuncture can help you quit, but it can’t make you quit.

Breaking the physical addiction

quit.v Can You Wait 5 Minutes? A Guide to Quit Smoking
Most seasoned smokers purchase their cigarettes in cartons. I myself smoked the Benson & Hedges (regular) brand of cigarettes. The first thing I did when I began to ramp down my addiction was to switch to Benson & Hedges Lights. They don’t taste quite as rich as the regular cigarettes, but you can get by with them, and after a carton or two, you’ll find that the light versions of your cigarettes will satisfy you eventually.
According to the National Cancer Institute, there is no evidence that switching to light or ultra-light cigarettes actually assists smokers in quitting. However, other research suggests that indeed low-nicotine ciggies can help fulfill the need for the smoke while working on the psychological aspect of the addiction. Worse case scenario is that putting all this effort into weening yourself down from regular ciggies to the ultra-lights may be more about your resolve and intent. In the end, resolve and intent are two components of a successful quitting process. So stick with me a little bit longer. :)
After you’ve gotten used to the lighter cigarettes, keep repeating this process until you’re smoking the lightest cigarettes that you can find. Benson & Hedges has another style that is lighter than their “light” ciggies. They’re called “Deluxe Extra Light”. So, after getting used to the “light”, I switched my next carton purchase to their “Deluxe Extra Light” style. Again, I had to go through a brief period of dissatisfaction with each new lighter cigarette but it is a small step that you can make peace with if you really want to quit smoking.
quit.c Can You Wait 5 Minutes? A Guide to Quit SmokingI need to at least make some medical statements at this point. Lighter cigarettes have not been proven to be any safer in regards to all those diseases that cigarettes cause. However, our goal is to get your body used to lower levels of nicotine. That’s why I encourage weening yourself down to the lighter cigarettes. There is also some who suggest that when a smoker moves to a lighter cigarette, they’ll compensate by smoking more often, holding the smoke in longer, or taking deeper breaths while smoking. All of these items would cause the net loss of tar and nicotine to rise again to their prior levels. Still, once you get used to the lighter cigarettes, you will smoke less tar and nicotine.
After I had transitioned to the Benson & Hedges Deluxe Extra Light cigarettes, I moved over to Carlton brand cigarettes. They were (still are?) marketed as the lowest in tar and nicotine. They have different types of cigarettes too. Their regular strength cigarettes are pretty low in tar and nicotine, but I found the taste to be unsatisfying and if I were to do this all again, I would stop at the Benson & Hedges Deluxe Extra Lights. Carlton’s lightest cigarettes have little holes in the filter to add more air to the mix. It is this added air that makes the machine that measures the tars and nicotine in the cigarette think that it is the lightest of all cigarettes. However, in real life usage, one’s fingers can be placed over these little holes which renders them somewhat ineffective. I don’t especially suggest that you move into the Carlton brand unless perhaps that is already your brand and you’re already used to them. If you’re already smoking one of the lighter forms of the Carlton brand, you’re already taking in a minimum of tar and nicotine, so you can move on to addressing the psychological addiction.

Breaking the psychological addiction

Breaking the psychological addiction too requires just a little bit of discipline and a lot of patience.
The first step is the most difficult for the heavily addicted smoker. However this baby step toward quitting smoking is also the most potent. The technique requires that you simply wait five minutes before having your cigarette. This is a huge step, it’s so important that the name of this article is based on this simple step. Can you wait five minutes? If you can, keep reading.
quit.w Can You Wait 5 Minutes? A Guide to Quit Smoking
Daddy can't play catch today, he's getting a lung biopsy.
Now, this doesn’t count if you can’t have a cigarette, anyway. If you’re on an airplane or in a restaurant or any other location where smoking is not allowed, then you’re really not waiting five minutes, you’re simply not allowed to smoke. While being on an airplane prevents you from smoking for a period of time, it does not help you to break the psychological addiction, except perhaps as proof that you can live without a cigarette. Still, it is the act of waiting because of your own choice that matters.
Research has timed out a typical cigarette craving and found it to be a surprisingly short time, ninety seconds on average. That’s a minute and a half that you’ll be a little bit uncomfortable. Waiting five minutes to have that cigarette isn’t about enduring the cravings, its about taking control over them. One of the essential core realities with addictions is that something has control over you. Your cravings decide when you’ll have your next cigarette, not your own choice. Waiting five minutes simply puts you back in the driver’s seat and that makes all the difference in the world.
I have to tell you, when I quit smoking, I learned somewhere that the average period of craving was around ninety seconds. Now that I’m committing my thoughts to an on-line article, I’ve been looking for some corroboration on this statistic, but I haven’t really found much. Out of the 50 sites I looked at, only one mentioned that the period of cravings is said to last only “a couple of minutes”. Somewhere out there is a more definitive answer, but for now it is enough to understand that the cravings last nowhere as long as you may think.
To me, waiting five minutes is much like the Boston Tea Party where American rebels threw a bunch of tea from England into the Boston Harbor to protest England’s King George’s taxes. It is a little bit like Ghandi removing a grain of salt from the ocean to break the monopoly that the British had on salt production in Colonial India. Waiting five minutes is a small act with big consequences. You learn that you can control yourself, you learn that you CAN do it. You poke a hole in the control that cigarettes exert over you, and it only takes five minutes.
Again, this five minute period only applies to those times when you can have a cigarette. It doesn’t count if you really can’t have a cigarette like when you’re in a non-smoker’s home or some other limitation. However, when you’re in your car, in your home, or wherever else where you can freely smoke, THAT’S when you’ll want to wait your five minutes.
Once you’re convinced that you have control again over when you smoke, you can start to lengthen that five minute period. Remember, once you start to wait five minutes, you’ll quickly come to understand that the cravings are not lasting the entire five minutes, they last much less than that. When I was in this phase of quitting, I found that sometimes I would forget to have my cigarette. It kind of depends on what you’re doing with your time. If you’re just sitting there, watching the clock, waiting for the five minutes to pass, chances are you’re not going to forget to have your cigarette. However, getting busy with some other activity instead of having your cigarette can easily give rise to forgetting about it entirely. I might add that this selective attention is enhanced by meditation which can also have profound effects on your life in general (but that’s a whole ‘nother story.)
After you’ve taken back control over your cigarette intake, you can begin to lengthen that five minute period. I myself found the knowledge that I can have a cigarette in the future to be quite comforting during this period. Knowing that you CAN and WILL have a cigarette sometime in the future is going to be the last crutch that you can lean on, and that’s okay.

Breaking the physical and psychological addictions simultaneously

The next step is to start poking holes in the physical and psychological addiction simultaneously. This can be done by only smoking during the odd hours. If you have some superstitious issue with odd hours and would prefer to smoke only during the even hours, you have my blessings. It doesn’t matter really. Just don’t go changing the rules once you’ve begun the process. Cheating doesn’t help you and only you will know if you’re cheating.
If you haven’t yet begun to even act on the suggestions found earlier in this article, these ideas here may seem daunting, however the whole idea here is to remember that we became addicted to cigarettes in baby steps and we can quit smoking with baby steps.
At this point, you’ve done some excellent work to lower the amount of nicotine that you’re getting from your cigarettes to break the physical addiction. You’ve found that you can actually control when you have that next cigarette by waiting five minutes, and you’ve even been able to stretch that little hole much larger by only smoking during the odd numbered hours.

Acupuncture therapy for smoking cessation

At this point, some people may feel ready to take the plunge, get some acupuncture treatments and put down those cancer sticks. However, if you want to stretch this addiction hole out a little bit larger, you can continue to back off your cigarette usage to one in the morning, one in the afternoon, and one in the evening.
If you’re down to three cigarettes per day, you’re more than ready to put them down. Now, it is only a crutch, not an addiction. You’ve done it, you’ve quit. All you have to do now is stop smoking. The irony in this statement has not gone unnoticed. : )
Three treatments in the first week is going to do the trick to put you into the “non-smoker” category. In the protocol that I use, I insert five needles into the ear (actually into the cartilage, not really into the ear canal) and a few on the hand and wrist. I apply the needles three times in that first week. This has a significant effect on lowering cravings and calming you down. The needles are left in for between 20 and 45 minutes.
quit.s.bs Can You Wait 5 Minutes? A Guide to Quit Smoking
The brand of Chinese cigarettes called "smart" is made by a company who's initials are "BS". More than a coincidence? (BS is American slang for "untrue")
There’s another benefit to acupuncture for quitting smoking. Nobody really knows why, but it is a well-known effect. After the acupuncture, cigarettes actually taste foul. Cigarettes taste like a wet ashtray smells, and you know how disgusting that is. I call this the Clockwork Orange effect. After your acupuncture, even if you do try and have a cigarette, the taste will have you spitting until your mouth is dry and searching for mints to remove that nasty burnt taste. It’s very strange but fortunately, this Clockwork Orange effect works to your favor to help you quit.
Another added benefit of putting down your cigarettes is that you’ll be able to redefine yourself. You are now a non-smoker. Say it again: “I am a non-smoker”. Its a great feeling and one that I choose to protect to this day.
For this reason, it is suggested that at the four week mark you have another treatment, then again at the eight week mark. If you can avoid smoking for three months, you’re pretty much done. Once you’ve had your initial three treatments, you may go a month without smoking and forget how much focus and resolve it took. You’ll be thinking, “that wasn’t so difficult, I can have a cigarette without falling back into the habit…” and the next thing you know, you’re a smoker again. This tends to happen after the one month mark, and again after the two month mark. That’s why I suggest booster treatments at the four week mark and then again at the eight week mark.
quit.m Can You Wait 5 Minutes? A Guide to Quit Smoking
Prepare for your cravings
Identify your triggers. I myself loved a cigarette in the morning with a cup of coffee. Then again, after meals. There are many different activities in which you just naturally look for your cigarette without even thinking about it. Activities, foods, and times all carry with them a sort of psychological trigger for a craving. If you can plan for these cravings by having some gum available or anything that you feel might fill in that cigarette craving, you’ll do much better with your quitting process.
Avoid smokers
Spend some time away from your smoking friends and family as is possible. When everybody is smoking, this makes it especially difficult to quit. Be ready in these situations with healthy carrot sticks or even unhealthy candies. Candy is far more easy to give up than cigarettes. I know that weight gain is a concern among smokers, but keep in mind that when you quit smoking, you’ll have more energy to exercise and feel better in general.

Remember how it felt to have to smoke

When you’ve finished quitting, read this article about smokers in Minnesota. It’ll warm your heart knowing that you’ve quit while it chills your soul thinking about those who haven’t.

The Leather, Tympanic, Drum-Skin Pulse (Ge Mai)

Leather Pulse (革脈 Ge Mai, tympanic, drum-skin)

Key points: superficial, forceful, taut, wide, and hollow

Indications: blood loss, abortion, jing exhaustion: sudden loss of blood or jing causes qi to float with the hollow insides due to sudden lack of blood or jing.
Explanation: this is a situation where a sudden and profound loss of blood or jing (these two are commonly related as they can transform into one another) causes the pulse to share aspects of deficiency and excess.
The way that this works is thus: you have a normal pulse, but then there is a sudden loss of blood. This is likely going to be due to trauma, though I wouldn’t be surprised to see this pulse arise after childbirth either. Now you’ve got a sudden loss of substance within the vessels. With blood loss, there will be qi loss, but not yet. There’s still plenty of qi pushing a lower volume of blood. Now you have a dysregulation between opposing components. There’s too much qi and not enough blood. This gives rise to a relative excess of qi in much the same way that a deficiency of yin can cause symptoms of heat. Now, applied to the qualities of this pulse, that relative excess of qi will show up as a forceful and wide, even hard (taut) pulse. However it is also hollow meaning that it is strong superficially, and palpable deeply, but it has no force at the middle depth. That’s what hollow means. This lack of “middle” is consistent with the loss of blood or jing that the patient has recently experienced. Got it?
p.leather The Leather, Tympanic, Drum Skin Pulse (Ge Mai)

The Leather Pulse
4.1.40.table The Leather, Tympanic, Drum Skin Pulse (Ge Mai)

Comparison of Leather and Hollow Pulses

The Qualities of Qi in Meridian diagnosis

One of the earliest known methods of diagnosis in Chinese medicine was reading the flow of qi through the meridians and organs. This was done be sensing the energy flow with the hands, fingers, and eyes.
This is still a major technique, and can be accomplished by holding a meridian end point at a given subject’s finger or toe, and passing the free hand over the path of the meridian and the corresponding organ. Any changes in the Qi flow indicate an imbalance in relation to the anatomic position where the change occurred, or in the organ. Some practitioners hold the right finger or toe of a female and the left hand or toe of the male. There are also practitioners who treat using methods similar to diagnosis with External Qi Gong.
The following qualities of Qi can be felt by the hands only with a little practice. The “feel” can then be translated into a communicable system which describes the condition of the individual areas.
The following represents some of the information presented in an excellent class on Tui Na taught by Sifu Carl Totten at the Taoist Institute in North Hollywood, California. Many of these qualities of Qi listed below include the associated pathology to which they correspond. Many do not. For those that do not, we’ll let you decide what they mean. -al.

Heat:

From warm to hot, the knowledge of heat measures yang.

Cold:

From cool to cold, the knowledge of cold measures yin.

Attracting-Magnetic-Pulling:

When one senses that the energy is being drawn from one’s hand into the subject’s body, the following possibilities are indicated:
The attracting field is the result of an energy deficiency which is draining energy from its surroundings in order to maintain balance.
The attracting field is overly strong, and it is draining energy from its surroundings.
The examiner’s personal energy is not centered or in balance, and, as a result, their energy is being drawn off. The examiner should then center their own energy.

Repulsing-Pushing Away:

The subject’s aura (external yang field) has been emotionally triggered by the presence of the examiner, and is pushing away. This could be indicative of a psychological disturbance, so as to suggest that the patient’s body or mind does not want the examiner’s hand or person close by.
Internal energy from internal disturbance is affecting the external aura.

Recoiling:

Injured, or alarmed, sensitive. The energy withdraws and tightens, then relaxes and approaches.

Tingling, electric:

This indicates the intensity of both yin and yang.
Hot:
With widely dispersed tingles indicates irritation.
With tingles close together indicates pain. This energy should be approached carefully from a distance in that it could prove painful for the examiner to feel it in the hands. If the energy should flare into the hands, the examiner should relax their muscles and breath the energy into the ground. They should make no resistance to the passage of the energy. This is the energy of excess.
Cold:
This indicates what is lacking, and its pain is the sharpest.

Smooth:

Its flow is smooth on the surface, and on the interior.

Rough:

Its flow is rough, irregular. It is rough on the surface and on the interior. Rough is insufficient, breaking up, diminishing.

Steady:

Without variation.

Thick:

Having density.

Thin:

Having little substance or reserve.

Solid:

No variation in density.

Hollow:

Having the external appearance without the internal substance.

Slow:

A diminished energy unless it is normal for the subject.

Fast:

Usually indicating that which is excited, unstable, or out of control. To be fast is to burn up quickly.

Weak:

Almost empty.

Strong:

Enduring solidity.

Loose:

Unattached, unstable.

Tight:

Restricted, taut, as in strangled.

Sluggish:

A normal energy which is slow. The beginning of disharmony.

Pulse Education and Translation Problems

ne of the more frustrating problems Chinese medicine folks have in the English speaking world is getting past translations of pulse terms to arrive at less ambiguous descriptions of these different pulses.

Pulse translations problems:
  • Names of pulses are inconsistent between books.
  • Translation needs vary.
  • Poetic Chinese explanations provide little help.
Examples of inconsistent pulse names:

Pinyin Maciocia CAM Wiseman Eastland
se.mai Pulse Education and Translation ProblemsSechoppyhesitantroughchoppy
ruo.mai Pulse Education and Translation ProblemsRuoweakweakweakfrail
ru.mai Pulse Education and Translation ProblemsRuweak-floatingsoftsoggysoggy
Translations needs vary:
  • Denotative or literal translations:
    ru = soggy (also translates to “immerse” or “moisten”)
  • Connotative or implied translations:
    ru = soft. What the early diagnosticians may have been trying to describe is a feeling that the pulse is soft, not hard.
  • Functional translations:
    ru = weak-floating. I believe that these are the most useful translations for the needs of English speaking practitioners. It describes the simple parameters that make up a complex pulse. This pulse is weak and floating. Now weak and floating I can figure out. Soggy? I have no idea how that is going to feel.
Classical Chinese explanations:
Poetic pulse descriptions don’t help too much, although they’re fun. Let’s see if you can guess which pulses are being described in the samples below. Mouseover the word “answer” for the answer, you don’t have to click, just move your little pointer over the word “answer” and it should magically appear.

Generalities to Guide Clinical Practice (A Quick Guide)

There are certain answers that come up frequently during the “inquiry” phase of the diagnostic interaction in Chinese medicine.
For instance, whenever you see secretions or excretions that are yellow, no matter where they appear, the diagnostic significance always points to heat. The same can be said of clear or white secretions, they indicate cold. That can be speaking of urine, phlegm, or any secretions, even ejaculate. (I should note that ejaculation *should* be white, but not clear which might indicate a Kidney deficiency such as yang deficiency in which case we could say this indication suggests internal cold of the deficiency type.)
As is the case with all of Chinese medicine diagnostics, these findings need to be triangulated (quadrangulated?) with the three other pillars of diagnosis, namely palpation (including pulse diagnosis), observation (including tongue diagnosis), and “listening/smelling”.
These generalities can easily guide a practitioner toward relevant, accurate, and efficacious diagnosis. Enjoy.

GLOBAL GENERALITIES
Discharges
Clear and copiouscold
Yellow and scantyheat
Cloudydamp
Pustoxicity
Yellow to greenheat
Thin and wateryphlegm damp
Hard and difficult to expectoratedry phlegm
Pale pink, red, or purple urinebleeding
Sounds
Loudexcess
Softdeficiency
Aggravation
worse with reststagnation
worse with fatiguedeficiency
worse with heatheat
worse with coldcold
worse with damp weatherdamp in the channels
worse with pressureexcess
increases by eatingexcess
after sexkidney deficiency
with stressLiver Qi stagnation
before periodLiver Qi stagnation
after periodBlood deficiency
Amelioration
better with restdeficiency
better with movementstagnation
better with heatcold
better with coldheat
better with pressuredeficiency
diminishes with eatingdeficiency
Appearances
Redheat
Pale and flacciddeficiency
Pink or pale redyin deficiency
Nodular or lumpystagnation of Qi, Blood, or phlegm (or combination of the three)
Red with pusheat with toxicity
Pain
pain migratesWind in the channels
red, swollen, hot jointsheat in the channels
dull, distended, larger areaqi stagnation
sharp, fixed, smaller areablood stagnation
heavy paindamp
cramping paincold
burning painheat
Onset
Acute onset, short durationexterior
Slow onset, chronic durationinterior
excess pathologies tend to run their course quickly and are more intense.
deficiency pathologies tend to run chronically and are low-grade.
Times ‘O The Day
Dawnshao yang
Middaytai yang
Afternoon to duskyang ming
Dusk to midnightshao yin
Midnight to 3 amtai yin
3 am to dawnjue yin
Age
elderlytend to suffer from deficiencies
youthtend to suffer from excesses
childrencan be excessive or deficient
Liver Signs
Pathologies that are coincidental to the periodgenerally indicate a Liver involvement.
Pathologies that are stress inducedgenerally indicate a Liver involvement.
Gender Specific Issues
Women tend to suffer from a deficiency of Blood (through menopause, then Yin)
Men tend to suffer from a deficiency of Yin or Yang or Jing
Food and Drink
desire for warmcold
desire for coldwarm
Areas of Domination
flanksgall bladder
hypochondrium (includes back and front)Liver
lumbus (low back)Kidney
epigastric region (below ribs on midline)Stomach
“alternating” thingsShao Yang (GB)
one sided thingsShao Yang (GB)
File under “Duh”
coughLungs
palpitationsHeart
diarrheaSpleen

Pulse Qualities and Mechanisms (A Quick Guide)

Pulse diagnosis is among the more difficult aspects of Chinese medicine to master. One reason for this is incomplete education.
In this article, pulse qualities are described, along with the mechanisms behind these findings and of course their therapeutic indications.
Understanding mechanisms simplifies this study greatly. Complex pulses such as the soggy (ru mai) aren’t so complex when you understand the basis for it’s quantifiable parameters.

SPEEDFASTSLOW
STRENGTHFORCEFULFORCELESS
LENGTHLONGSHORT
WIDTHWIDETHIN
DEPTHSUPERFICIALDEEP
RHYTHMREGULARIRREGULAR
ABNORMAL PULSE SHAPESCHOPPY, WIRY, SLIPPERY

FAST AND SLOW
PULSE INDICATIONS MECHANISM
Fast PulseHeatHeat accelerates movement.
fast+forcefulexcess heat
fast+thindeficiency heat

Slow PulseWater element pulsecoldCold impedes movement. The so-called “Athletic Pulse” is also a slow pulse, but it only indicates cardiac health.

FORCEFUL AND FORCELESS
PULSE INDICATIONS MECHANISM
FORCEFUL Pulsesexcess
Surging Pulse
(floating, wide, forceful, comes stronger than it goes)Fire element pulse
excessive heatHeat stimulates the Heart’s function of commanding the Blood leading to increased cardiac output and the forceful pulse. However, heat damages the yin, which leads to a component of deficiency in this pulse. The deficient component is the downslope of the pulse wave which is weaker than the upslope of the pulse wave. Also, this is often considered a floating pulse. When the yin is damaged, it loses its root and floats.

Forceless Pulsesdeficiencydeficiency of Qi or Yang gives rise to the forceless pulse.

LONG AND SHORT
PULSE INDICATIONS MECHANISM
Long Pulseexcessive heatHeat accelerates and expands. When the pulse is long and too forceful, this is excessive heat. When the long pulse is moderate in force, this is a healthy pulse.

Short Pulse

short+forcefulQi stagnationStagnation prevents Blood from filling the vessel.
short+forcelessQi deficiencyQi can’t push Blood hard enough to fill the vessel.

WIDE AND THIN
PULSE INDICATIONS MECHANISM
Wide Pulseheat
wide+forcefulexcessive heatHeat accelerates and expands.
wide+forcelessdeficiency heatYang expands the width of the vessel because Yin is too deficient to anchor it.

Thin Pulse deficiency of Qi, Blood, or YinQi, Blood, or Yin can’t fill the vessel with fluid or pressure to expand the width of the vessel.

SUPERFICIAL AND DEEP
PULSE INDICATIONS MECHANISM
Superficial Pulse
Metal element pulse
superficial+forcefulexterior syndromeYang floats to the exterior (as Wei Qi) to fight off invasion of exterior pathogenic factor. This is reflected metaphorically in the superficial pulse.
superficial+forcelessYin deficiencyYang floats to the exterior because Yin cannot anchor it. This is reflected metaphorically in the superficial pulse.

Deep Pulse
deep+forcefulinternal coldpathological cold both injures Yang and impedes its rising. This is reflected metaphorically in the deep pulse.
deep+forcelessYang deficiencyA deficiency of Yang gives rise to the inability for Qi and Blood to lift upwards. This is reflected metaphorically in the deep pulse.

REGULAR AND IRREGULAR
PULSE INDICATIONS MECHANISM
Regular Pulsehealth
Intermittent Pulse
(regularly irregular)
Rather than focusing too much on the indications of this pulse, I want you to remember that this may be a red flag for you and a referral to a cardiologist may be indicated.
Abrupt Pulse
(rapid, irregular rhythm)
heat stagnation or stagnation heatThis pulse indicates stagnation that gives rise to heat, or heat that is causing stagnation. In either case, we have stagnation and heat.
Knotted Pulse
(slow, irregular rhythm)
Blood Stagnationpathological factors (likely cold) impede movement of Blood

ABNORMAL PULSE SHAPES
PULSE INDICATIONS MECHANISM
Choppy PulseBlood Stagnation
choppy+forcefulBlood Stagnationexcessive pathological factors impede movement of Blood
choppy+forcelessBlood Stagnationlack of Qi, Blood, or Jing leads to vessels that aren’t filled which inhibits free flow of Blood.

Wiry PulseWood element pulseStagnationNei Jing says “tendons are the mother of vessels” which is to say that when the Liver becomes dry, so do the tendons, which leads to a hardness in the pulse as it loses the vessels lose their flexibility.
Another mechanism is Qi stagnation prevents Blood from circulating outward and so the pressure remains high in the vessels causing the hard (wiry) pulse.

Slippery PulseEarth element pulseDampnessDampness in the Blood increases its viscosity giving rise to a pulse that lacks corners.

HeatHeat accelerates the movement of the Blood giving rise to the perception of the pulse losing its corners.