Ask any recent graduate about their education and they'll complain about two things: 1) They didn't learn enough about marketing; and 2) They didn't spend enough time on pulse diagnosis. It doesn't matter if someone took a two-year master's or a five-year diploma; it's safe to say pulse diagnosis was rammed, crammed and jammed somewhere in the middle of a foundations of Chinese medicine course.
I also believe honesty should come forward, while mystery should take a back seat. Pulse, in its inception, was a somewhat objective skill. Today, pulse is often touted as a very subjective skill, and is shrouded in secrecy and unattainable wisdom.
Bob Flaws, in his book The Secret of Pulse Diagnosis, translates a pulse poem for us. It is a poem that mentions basic diagnostic values that are very useful in the clinic, reinforcing the idea that fundamental knowledge is key when feeling a patient's pulse. What is typically done to date complicates matters by forcing categories and intricate definitions onto pulse types.
The Eight Principles and Pulse Diagnosis
When learning Chinese medicine, one is exposed to Eight Principle diagnosis. The purpose of this process is to simplify complicated cases into either interior and/or exterior, cold and/or heat, deficiency and/or excess, and yin and/or yang.
If a condition is on the interior, we are to treat the zang-fu, while if it is on the exterior, we are to release the external pathogenic factor. If a condition is cold, we are to warm; if it is warm, we are to cool. If a condition is deficient, we are to bolster or tonify, and if it is excess, we are to drain or reduce. If a condition is yin, we do more yang action; if it is yang, we do more yin action.
Pulse diagnosis behaves exactly the same. In fact, the poem Bob translated is called "The Song of Eight Principles Pattern Discrimination, Pulse & Tongue, Patterns & Treatment." The simplicity is really quite genius.
A deep pulse means the condition is in the interior. A floating pulse means the condition is on the exterior. A slow pulse means cold. A rapid pulse means heat. A weak pulse means deficiency. A forceful pulse means excess. And, of course, these can be combined. For example, if a pulse is deep and slow, this is diagnosed as interior cold.
One can very well lean hard into these six diagnostic values for the remainder of their career. Mastery of a small amount of information is called specialization and this often gets a person very far. For those who want to venture further, there are, of course, the 29 diseased pulse images.
The 29 Pulse Images: How Many Do You Use?
The number of diseased pulse images initially seems quite excessive. For a moment, let's pretend we could peer into everyone's patient charts to see what they write down for pulses. I would posit that Pareto's Principle would reign supreme: 80 percent of the time, practitioners use the same 20 percent of pulses – that's six pulses of the 29.
Actually, six is a great number to start with when it comes to memorizing pulse images. Six is manageable. Six can be mastered. And we must remember that our core six are actually real, stand-alone pulses: floating, deep, rapid, slow, weak, and forceful.
While we can't peer into everyone's patient charts, we can peer into mine. I know that I rotate between a core group of pulses, with new ones being added every few years as I gain more experience: floating, deep, rapid, slow, weak, forceful, slippery, thready, bowstring, choppy, drumskin, skipping, and regularly interrupted.
As recent graduates start their work in student clinic, it's likely they will be able to add those pulses to their repertoire quite quickly as well. Together, we have 13 pulses. Before a practitioner graduates Chinese medicine school, they are able to, more or less, identify 13 pulses. And they have their whole career to develop the rest.
An Important Part of the Diagnostic Picture
We've all heard stories about some gifted practitioner who could look into a crystal ball just by feeling a radial artery. Regardless of whether this is true or not, we need to ask ourselves if this is a valuable skill to have. Is depending on one single sign or symptom how traditional East Asian medicine works?
As we progress in our Chinese medicine education and careers, we learn the value of gathering lots of information. A one-legged stool is very unstable – so unstable that to develop a treatment protocol based on one sign or symptom would be asinine. I doubt any practitioner would develop a protocol based on bowel movements alone. Therefore, pulse diagnosis is as important, but not more important, than any other diagnostic.
I have met many practitioners who no longer take a pulse, and I find this quite sad. They've told me they just don't understand it or that they didn't really learn it. However, by using the six basic pulses at every patient visit, we observe two things: 1) We can get some seriously helpful diagnostic information every time we feel a pulse; and 2) We just might know more about pulse than we think.
Click here for more information about Kenton Sefcik, RAc, Dipl. Ac., Dipl. TCM.