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Those are the only pulses and details in 98% of the clinical cases

that I encountered while attending clinic rounds at Five Branches (Santa

Cruz, CA.) the Oriental Heath Sciences Academy (Oakland,CA. - sorry I seem

to have forgotten their name)and the now defunct San Francisco College of

Acupuncture. All my clinical teachers were from Taiwan or Shanghai. My

tutorial teacher (Dr Wu from Tianjin, China) was better with more nuances,

like Kidney Yang Floating and would bring me in to feel any unusual pulses.

But again in his diagnosis for me would give only the main pulse sign. The

tongue played a prominent role. BTW he's and excellent herbalist.

 

My 5 element friends all know pulses far far better than I - except they

don't know herbs.

 

<<snipped>> The vast majority of instances I found were for three qualities:

 

1. slippery in the spleen position

 

2. wiry in the liver position

 

3. weak in the kidney position

 

Ed Kasper L.Ac., Santa Cruz, California

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Ed et al.,

 

Given the nature of our out-patient clientele, their lifestyles, age, sex,

and the kinds of problems that we are primarily called on to treat, only

approximately half of the 28 pulse images present on a day in/day out basis

(at least in terms of mainstream Chinese pulse diagnosis as practiced since

the late 16th century on the Mainland). In my experience, these are:

 

1. Slippery

2. Bowstring

3. Fine

4. Soggy

5. Floating

6. Deep

7. Fast

8. Slow

9. Moderate (i.e., slightly slow)

10. Knotted

11. Intermittent

12. Vacuous

13. Short (meaning the pulse does not reach into the inch position)

 

Some of these are already compound pulses (i.e., pulse images made up of

elements of one or more simpler pulse images). For instance, the soggy

pulse is floating, fine, and forceless. The vacuous pulse is floating,

large (i.e., wide), and forceless. In addition, most of the rest of the 28

are only more extreme variations of these core 13. For instance, the faint

pulse is only very, very fine and forceless. The weak pulse is only deep,

slow, and forceless. The hidden pulse is only very, very deep, and not

particularly forceful, etc. If one memorizes these definitions, these other

pulses are not at all difficult to feel and identify when they happen to

appear.

 

Some of the other 28 pulses are so extreme that we just don't see them in

our mostly out-patient, " walking wounded, " chronic disease settings. If you

want to feel the scallion-stalk, racing, water-dripping, shrimp swimming

pulses, you need to ride in an ambulance, work in the ER or in ICU. Or you

need to hang out with patients in hospices.

 

Otherwise, in our clinical practice in the U.S. and Europe, the key trick

is not to feel and distinguish the pulse images that tend to repeat over

and over again (that's relatively easy!), but to interpret what these pulse

images mean when they show up in combination in the different positions.

 

One of my Chinese teachers in Shanghai in 1982 pleaded with me not to

mystify myself. If took me another half dozen years to understand and

ACCEPT what she was trying to tell me. I was so biased by my orientialist

romanticism, I just couldn't let her advice based on 20 years of experience

in. My cup was too full. I suspect my advice is going to fall on a lot of

deaf ears. It certainly has in the past. But I think I do understand where

a lot of us are coming from since I came from exactly the same place or

even more so. Please, as a profession, let's not over-mystify pulse

examination.

 

This is a general tendency many of us have within this profession, and my

experience is that this tendency is even more pronounced when it comes to

the pulse. It is so easy for charlatans (even in China) to bamboozle the

uninitiated about this. This is exactly why Zhang Jing-yue, one of the

greatest medical thinkers and writers of his day (late Ming) said that

pulse examination should come AFTER looking and questioning. In order to

emphasize the role of questioning and de-romanticize, de-mystify the pulse,

he authored the 10 Questions.

 

We don't need to make this method of examination any more difficult than it

is. A pattern (zheng) is made up of the convergence and corroboration of

three streams of information based on the Four Examinations: 1) general

signs and symptoms, 2) tongue signs, and 3) pulse signs. Since treatment in

standard professional Chinese medicine is ultimately predicated on pattern

discrimination (bian zheng lun zhi), the information we need to gather to

plan our treatments is only that information necessary to confirm or deny a

pattern discrimination (also given the fact that most of our patient's have

5-10 patterns SIMULTANEOUSLY). This does not require anything more than the

28 pulses. In fact, methodologically, this process cannot currently

accomodate anything more than the 28 pulse and 10 death pulses. (To

accomodate more pulse images, we would have to redefine the " standard "

signs and symptoms of our " standard " patterns.)

 

If one has 5-10 patterns presenting simultaneously, the trick is not to

feel some arcane, esoteric pulse but to interpret what a specific

combination of pulse images mean in a particular patient at a particular

moment in time. For instance, let's say the patient has the following pulse

images:

 

Speed: slightly fast, 90 bpm

 

Rt:

Inch: Vacuous

Bar: Soggy, slightly slippery on pressing and searching

Cubit: Slippery, bowstring, and deep, but only normally deep, not

abnormally deep

 

Lft:

Inch: Soggy

Bar: floating, bowstring & fine

Cubit: floating, bowstring & fine

 

This is a real-life pulse picture taken from my patient files. Even without

the corroborating general signs and symptoms and tongue signs, we can say

the following things about the patient's probable patterns (which we then

could easily corroborate by those signs and symptoms and tongue signs):

 

The right bar soggy pulse tells us there is a spleen qi vacuity with

probably engenderment of dampness and the spleen not engendering and

transforming the blood. The left bar position tells us there is liver

depression qi stagnation at least in part associated with blood and yin not

nourishing and moistening the liver. The fact that the right bar is

slightly bowstring on pressing and searching tells us the liver is invading

the spleen. So now we know there is a liver-spleen disharmony.

 

The right cubit position tells us that there is dampness and probably heat

in the lower burner (due to spleen vacuity). the sligfhtly rapid pulse

tells us there is some sort of evil heat, probably vacuity but definitely

associated with vacuity. The left cubit position tells us that there is

kidney yin vacuity. (Now we know there is dual liver-kidney yin vacuity).

 

The floating images in the inch positions further confirm there is yin

vacuity (yin not controlling yang which is counterflowing upward). The

right inch suggests that the lung qi is also vacuous due to a probable

combination of A) the heat of damp heat below ascending to collect in the

lungs and consume the qi and B) spleen vacuity not upbearing the clear to

form the ancestral or chest qi. The left inch suggests that the heart

spirit is not being constructed and nourished properly, and so there are

probably symptoms of the spirit not being quiet or calm.

 

From here you need to have a good grasp of advanced Chinese medical theory.

Since the bowstring pulse suggests that the qi is not flowing freely,

especially in the lower part of the body, we might expect menstrual or

reproductive pain in females and/or damp heat urinary or impediment

problems in both males and females. Because the qi moves the blood and

because of the interrelationships of the six depressions (liu yu), qi

stagnation may have given rise to blood stasis, but we may have to confirm

this by one of our other streams of information, NOT the pulse. Further,

since damp heat may cause ministerial fire to stir or counterflow upward,

thus leaving its lower source vacuous and cold, there may be kidney yang

vacuity below which also does not manifest in the pulse but which must be

confirmed or denied by other streams of information, such as questioning.

Because of the interrealtionship between former and latter heavens,

long-standing spleen vacuity may easily lead to kidney yang vacuity. Sex

and age will also play their part in determining the presence of such yang

vacuity which commonly does NOT manifest in the pulse because the pulse is

located in the upper part of the body and heat (which is yang) inherently

travels upward. Another way to explain this is to say that the pulse is

ruled by the heart (xin zhu mai) and the heart is in the upper part of the

body. In either case, in most cases of yang vacuity in our patients, yang

vacuity does not manifest as a slow, deep pulse. In fact, it only manifests

in the pulse at all by indirect inference, not direct image.

 

This process has its own complexity, but it is not the complexity of some

supernormal dexterity, mystical intuition, or esoteric knowledge. It has to

do with 1) feeling relatively easy to distinguish feelings, 2) labelling

these feelings, and then 3) interpreting these feelings correctly when

taken as a total gestalt.

 

In terms of the pulse example above, this patient's patterns are: 1) a

liver-spleen disharmony (this is an abbreviation for saying A) liver

depression qi stagnation and B) spleen qi vacuity weakness, 2) dual

liver-kidney yin vacuity (with possible yang vacuity yet to be

established), 3) probably damp heat impediment complicated by 4)

malnourishment of the sinews, 5) possible blood stasis, and 6) lung-heart

vacuity at the very least. Since a lung qi vacuity is as good as saying a

defensive qi vacuity, this person is easily susceptible to external

invasion. So the presence of external evils lodged in the exterior (7)

would also have to be considered.

 

Capisce?

 

Bob

 

> [Original Message]

> HappyHerbalist.com <Health

>

> 05/21/2000 5:18:48 PM

> RE: pulses

>

> Those are the only pulses and details in 98% of the clinical cases

> that I encountered while attending clinic rounds at Five Branches (Santa

> Cruz, CA.) the Oriental Heath Sciences Academy (Oakland,CA. - sorry I

seem

> to have forgotten their name)and the now defunct San Francisco College of

> Acupuncture. All my clinical teachers were from Taiwan or Shanghai. My

> tutorial teacher (Dr Wu from Tianjin, China) was better with more nuances,

> like Kidney Yang Floating and would bring me in to feel any unusual

pulses.

> But again in his diagnosis for me would give only the main pulse sign. The

> tongue played a prominent role. BTW he's and excellent herbalist.

>

> My 5 element friends all know pulses far far better than I - except they

> don't know herbs.

>

> <<snipped>> The vast majority of instances I found were for three

qualities:

>

> 1. slippery in the spleen position

>

> 2. wiry in the liver position

>

> 3. weak in the kidney position

>

> Ed Kasper L.Ac., Santa Cruz, California

>

>

> ------

> Missing old school friends? Find them here:

> http://click./1/4055/9/_/542111/_/958951117/

> ------

>

> Chronic Diseases Heal - Chinese Herbs Can Help

>

 

 

 

--- Robert Flaws

--- bobflaws

--- EarthLink: It's your Internet.

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As usual, I enjoy the clarity of Bob's material and points of view. He has expressed very important information in this posting in a practical and condensed manner.

 

For myself, however, I would like to point out that in my practice that I do see a lot of unusual pulses, especially se mai/scattered pulses, as well as the scallion-stalk and water dripping pulses. This may be because of the number of patients I see with cancer or lupus, who are undergoing chemotherapy and/or radiation and other strong biomedical treatments. So it is important that we teach and share them. Many of our students at PCOM are doing their clinical intership at a hospice, and see these pulses weekly.

 

Also, for practitioners of acupuncture, learning Nan Jing pulse techniques is essential; the pulse qualities that Bob describes are largely connected with internal, i.e. Chinese herbal medicine. I think Jim Ramholz emphasizes Nan Jing pulses in his work. However, the expression needs to be clarified. Without access to Wiseman translation terminology, pulse images become obscured and difficult to communicate.

 

 

 

 

 

>Given the nature of our out-patient clientele, their lifestyles, age, sex,

>and the kinds of problems that we are primarily called on to treat, only

>approximately half of the 28 pulse images present on a day in/day out basis

>(at least in terms of mainstream Chinese pulse diagnosis as practiced since

>the late 16th century on the Mainland). In my experience, these are:

>

 

>1. Slippery

>2. Bowstring

>3. Fine

>4. Soggy

>5. Floating

>6. Deep

>7. Fast

>8. Slow

>9. Moderate (i.e., slightly slow)

>10. Knotted

>11. Intermittent

>12. Vacuous

>13. Short (meaning the pulse does not reach into the inch position)

>

 

>Some of these are already compound pulses (i.e., pulse images made up of

>elements of one or more simpler pulse images). For instance, the soggy

>pulse is floating, fine, and forceless. The vacuous pulse is floating,

>large (i.e., wide), and forceless. In addition, most of the rest of the 28

>are only more extreme variations of these core 13. For instance, the faint

>pulse is only very, very fine and forceless. The weak pulse is only deep,

>slow, and forceless. The hidden pulse is only very, very deep, and not

>particularly forceful, etc. If one memorizes these definitions, these other

>pulses are not at all difficult to feel and identify when they happen to

>appear.

>

 

>Some of the other 28 pulses are so extreme that we just don't see them in

>our mostly out-patient, "walking wounded," chronic disease settings. If you

>want to feel the scallion-stalk, racing, water-dripping, shrimp swimming

>pulses, you need to ride in an ambulance, work in the ER or in ICU. Or you

>need to hang out with patients in hospices.

>

 

>Otherwise, in our clinical practice in the U.S. and Europe, the key trick

>is not to feel and distinguish the pulse images that tend to repeat over

>and over again (that's relatively easy!), but to interpret what these pulse

>images mean when they show up in combination in the different positions.

>

 

>One of my Chinese teachers in Shanghai in 1982 pleaded with me not to

>mystify myself. If took me another half dozen years to understand and

>ACCEPT what she was trying to tell me. I was so biased by my orientialist

>romanticism, I just couldn't let her advice based on 20 years of experience

>in. My cup was too full. I suspect my advice is going to fall on a lot of

>deaf ears. It certainly has in the past. But I think I do understand where

>a lot of us are coming from since I came from exactly the same place or

>even more so. Please, as a profession, let's not over-mystify pulse

>examination.

>

 

>This is a general tendency many of us have within this profession, and my

>experience is that this tendency is even more pronounced when it comes to

>the pulse. It is so easy for charlatans (even in China) to bamboozle the

>uninitiated about this. This is exactly why Zhang Jing-yue, one of the

>greatest medical thinkers and writers of his day (late Ming) said that

>pulse examination should come AFTER looking and questioning. In order to

>emphasize the role of questioning and de-romanticize, de-mystify the pulse,

>he authored the 10 Questions.

>

 

>We don't need to make this method of examination any more difficult than it

>is. A pattern (zheng) is made up of the convergence and corroboration of

>three streams of information based on the Four Examinations: 1) general

>signs and symptoms, 2) tongue signs, and 3) pulse signs. Since treatment in

>standard professional Chinese medicine is ultimately predicated on pattern

>discrimination (bian zheng lun zhi), the information we need to gather to

>plan our treatments is only that information necessary to confirm or deny a

>pattern discrimination (also given the fact that most of our patient's have

>5-10 patterns SIMULTANEOUSLY). This does not require anything more than the

>28 pulses. In fact, methodologically, this process cannot currently

>accomodate anything more than the 28 pulse and 10 death pulses. (To

>accomodate more pulse images, we would have to redefine the "standard"

>signs and symptoms of our "standard" patterns.)

>

 

>If one has 5-10 patterns presenting simultaneously, the trick is not to

>feel some arcane, esoteric pulse but to interpret what a specific

>combination of pulse images mean in a particular patient at a particular

>moment in time. For instance, let's say the patient has the following pulse

>images:

>

 

>Speed: slightly fast, 90 bpm

>

 

>Rt:

>Inch: Vacuous

>Bar: Soggy, slightly slippery on pressing and searching

>Cubit: Slippery, bowstring, and deep, but only normally deep, not

>abnormally deep

>

 

>Lft:

>Inch: Soggy

>Bar: floating, bowstring & fine

>Cubit: floating, bowstring & fine

>

 

>This is a real-life pulse picture taken from my patient files. Even without

>the corroborating general signs and symptoms and tongue signs, we can say

>the following things about the patient's probable patterns (which we then

>could easily corroborate by those signs and symptoms and tongue signs):

>

 

>The right bar soggy pulse tells us there is a spleen qi vacuity with

>probably engenderment of dampness and the spleen not engendering and

>transforming the blood. The left bar position tells us there is liver

>depression qi stagnation at least in part associated with blood and yin not

>nourishing and moistening the liver. The fact that the right bar is

>slightly bowstring on pressing and searching tells us the liver is invading

>the spleen. So now we know there is a liver-spleen disharmony.

>

 

>The right cubit position tells us that there is dampness and probably heat

>in the lower burner (due to spleen vacuity). the sligfhtly rapid pulse

>tells us there is some sort of evil heat, probably vacuity but definitely

>associated with vacuity. The left cubit position tells us that there is

>kidney yin vacuity. (Now we know there is dual liver-kidney yin vacuity).

>

 

>The floating images in the inch positions further confirm there is yin

>vacuity (yin not controlling yang which is counterflowing upward). The

>right inch suggests that the lung qi is also vacuous due to a probable

>combination of A) the heat of damp heat below ascending to collect in the

>lungs and consume the qi and B) spleen vacuity not upbearing the clear to

>form the ancestral or chest qi. The left inch suggests that the heart

>spirit is not being constructed and nourished properly, and so there are

>probably symptoms of the spirit not being quiet or calm.

>

 

>>From here you need to have a good grasp of advanced Chinese medical theory.

>Since the bowstring pulse suggests that the qi is not flowing freely,

>especially in the lower part of the body, we might expect menstrual or

>reproductive pain in females and/or damp heat urinary or impediment

>problems in both males and females. Because the qi moves the blood and

>because of the interrelationships of the six depressions (liu yu), qi

>stagnation may have given rise to blood stasis, but we may have to confirm

>this by one of our other streams of information, NOT the pulse. Further,

>since damp heat may cause ministerial fire to stir or counterflow upward,

>thus leaving its lower source vacuous and cold, there may be kidney yang

>vacuity below which also does not manifest in the pulse but which must be

>confirmed or denied by other streams of information, such as questioning.

>Because of the interrealtionship between former and latter heavens,

>long-standing spleen vacuity may easily lead to kidney yang vacuity. Sex

>and age will also play their part in determining the presence of such yang

>vacuity which commonly does NOT manifest in the pulse because the pulse is

>located in the upper part of the body and heat (which is yang) inherently

>travels upward. Another way to explain this is to say that the pulse is

>ruled by the heart (xin zhu mai) and the heart is in the upper part of the

>body. In either case, in most cases of yang vacuity in our patients, yang

>vacuity does not manifest as a slow, deep pulse. In fact, it only manifests

>in the pulse at all by indirect inference, not direct image.

>

 

>This process has its own complexity, but it is not the complexity of some

>supernormal dexterity, mystical intuition, or esoteric knowledge. It has to

>do with 1) feeling relatively easy to distinguish feelings, 2) labelling

>these feelings, and then 3) interpreting these feelings correctly when

>taken as a total gestalt.

>

 

>In terms of the pulse example above, this patient's patterns are: 1) a

>liver-spleen disharmony (this is an abbreviation for saying A) liver

>depression qi stagnation and B) spleen qi vacuity weakness, 2) dual

>liver-kidney yin vacuity (with possible yang vacuity yet to be

>established), 3) probably damp heat impediment complicated by 4)

>malnourishment of the sinews, 5) possible blood stasis, and 6) lung-heart

>vacuity at the very least. Since a lung qi vacuity is as good as saying a

>defensive qi vacuity, this person is easily susceptible to external

>invasion. So the presence of external evils lodged in the exterior (7)

>would also have to be considered.

>

 

>Capisce?

>

 

>Bob

>

 

>> [Original Message]

>> HappyHerbalist.com <Health (AT) HappyHerbalist (DOT) com>

>>

>> 05/21/2000 5:18:48 PM

>> RE: pulses

>>

 

>> Those are the only pulses and details in 98% of the clinical cases

>> that I encountered while attending clinic rounds at Five Branches (Santa

>> Cruz, CA.) the Oriental Heath Sciences Academy (Oakland,CA. - sorry I

>seem

>> to have forgotten their name)and the now defunct San Francisco College of

>> Acupuncture. All my clinical teachers were from Taiwan or Shanghai. My

>> tutorial teacher (Dr Wu from Tianjin, China) was better with more nuances,

>> like Kidney Yang Floating and would bring me in to feel any unusual

>pulses.

>> But again in his diagnosis for me would give only the main pulse sign. The

>> tongue played a prominent role. BTW he's and excellent herbalist.

>>

>> My 5 element friends all know pulses far far better than I - except they

>> don't know herbs.

>>

>> <<snipped>> The vast majority of instances I found were for three

>qualities:

>>

>> 1. slippery in the spleen position

>>

>> 2. wiry in the liver position

>>

>> 3. weak in the kidney position

>>

>> Ed Kasper L.Ac., Santa Cruz, California

>>

>>

>>

------

>> Missing old school friends? Find them here:

>> http://click./1/4055/9/_/542111/_/958951117/

>>

------

>>

>> Chronic Diseases Heal - Chinese Herbs Can Help

>>

>

 

>

 

>

 

>--- Robert Flaws

>--- bobflaws (AT) earthlink (DOT) net

>--- EarthLink: It's your Internet.

>

 

>

 

>

 

>------

>Missing old school friends? Find them here:

>http://click./1/4055/9/_/542111/_/959024080/

>------

>

 

>Chronic Diseases Heal - Chinese Herbs Can Help

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Zev:

 

Like you, I appreciate Bob's work. In fact, the Blue Poppy

translation of the Mai Jing is on my list of " Top 10 Books of the

Milleneum " in the next issue of OMJ. I've been emphasizing the Nan

Jing pulse information simply because it is the most recent in my

mind as this semester draws to a close, and it is conspicuously

absent in most discussions (and from what I can tell, missing from

teaching in general). Like you, I've probably seen all the movements

described by the Li Shi-zhen, and some that are not.

 

The theoretical information is easily available from the Nan Jing.

With several translations of the Nan Jing available, that information

need not be considered esoteric. Incorporating the Mai Jing

information into practice is more difficult. But each classic (in

the order: LSz, NJ, MJ) adds a greater depth and wider perspective

to the way we can practice pulse diagnosis. They fit together well.

 

Though it takes time and effort to learn the tactile part of it,

anyone with perseverence will greatly expand their knowledge.

Admittedly, it may take 1-3 years to develop proficiency; but this is

the case with most areas of Chinese medicine in general. In a few

years, I would expect this level of knowledge to become fairly wide

spread.

 

 

Jim Ramholz

 

 

 

 

 

, " "

<zrosenberg@p...> wrote:

> As usual, I enjoy the clarity of Bob's material and points of

view. He

has expressed very important information in this posting in a

practical

and condensed manner.

 

 

For myself, however, I would like to point out that in my practice

that

I do see a lot of unusual pulses, especially se mai/scattered pulses,

as well as the scallion-stalk and water dripping pulses. This may be

because of the number of patients I see with cancer or lupus, who are

undergoing chemotherapy and/or radiation and other strong biomedical

treatments. So it is important that we teach and share them. Many of

our students at PCOM are doing their clinical intership at a hospice,

and see these pulses weekly.

 

 

Also, for practitioners of acupuncture, learning Nan Jing pulse

techniques is essential; the pulse qualities that Bob describes are

<italic>largely</italic> connected with internal, i.e. Chinese herbal

medicine. I think Jim Ramholz emphasizes Nan Jing pulses in his

work.

However, the expression needs to be clarified. Without access to

Wiseman translation terminology, pulse images become obscured and

difficult to communicate.

 

 

 

 

 

 

 

>Given the nature of our out-patient clientele, their lifestyles, age,

sex,

 

>and the kinds of problems that we are primarily called on to treat,

only

 

>approximately half of the 28 pulse images present on a day in/day out

basis

 

>(at least in terms of mainstream Chinese pulse diagnosis as practiced

since

 

>the late 16th century on the Mainland). In my experience, these are:

 

>

 

>1. Slippery

 

>2. Bowstring

 

>3. Fine

 

>4. Soggy

 

>5. Floating

 

>6. Deep

 

>7. Fast

 

>8. Slow

 

>9. Moderate (i.e., slightly slow)

 

>10. Knotted

 

>11. Intermittent

 

>12. Vacuous

 

>13. Short (meaning the pulse does not reach into the inch position)

 

>

 

>Some of these are already compound pulses (i.e., pulse images made up

of

 

>elements of one or more simpler pulse images). For instance, the

soggy

 

>pulse is floating, fine, and forceless. The vacuous pulse is

floating,

 

>large (i.e., wide), and forceless. In addition, most of the rest of

the 28

 

>are only more extreme variations of these core 13. For instance, the

faint

 

>pulse is only very, very fine and forceless. The weak pulse is only

deep,

 

>slow, and forceless. The hidden pulse is only very, very deep, and

not

 

>particularly forceful, etc. If one memorizes these definitions, these

other

 

>pulses are not at all difficult to feel and identify when they

happen

to

 

>appear.

 

>

 

>Some of the other 28 pulses are so extreme that we just don't see

them

in

 

>our mostly out-patient, " walking wounded, " chronic disease settings.

If you

 

>want to feel the scallion-stalk, racing, water-dripping, shrimp

swimming

 

>pulses, you need to ride in an ambulance, work in the ER or in ICU.

Or

you

 

>need to hang out with patients in hospices.

 

>

 

>Otherwise, in our clinical practice in the U.S. and Europe, the key

trick

 

>is not to feel and distinguish the pulse images that tend to repeat

over

 

>and over again (that's relatively easy!), but to interpret what these

pulse

 

>images mean when they show up in combination in the different

positions.

 

>

 

>One of my Chinese teachers in Shanghai in 1982 pleaded with me not to

 

>mystify myself. If took me another half dozen years to understand and

 

>ACCEPT what she was trying to tell me. I was so biased by my

orientialist

 

>romanticism, I just couldn't let her advice based on 20 years of

experience

 

>in. My cup was too full. I suspect my advice is going to fall on a

lot

of

 

>deaf ears. It certainly has in the past. But I think I do understand

where

 

>a lot of us are coming from since I came from exactly the same place

or

 

>even more so. Please, as a profession, let's not over-mystify pulse

 

>examination.

 

>

 

>This is a general tendency many of us have within this profession,

and

my

 

>experience is that this tendency is even more pronounced when it

comes

to

 

>the pulse. It is so easy for charlatans (even in China) to bamboozle

the

 

>uninitiated about this. This is exactly why Zhang Jing-yue, one of

the

 

>greatest medical thinkers and writers of his day (late Ming) said

that

 

>pulse examination should come AFTER looking and questioning. In order

to

 

>emphasize the role of questioning and de-romanticize, de-mystify the

pulse,

 

>he authored the 10 Questions.

 

>

 

>We don't need to make this method of examination any more difficult

than it

 

>is. A pattern (zheng) is made up of the convergence and corroboration

of

 

>three streams of information based on the Four Examinations: 1)

general

 

>signs and symptoms, 2) tongue signs, and 3) pulse signs. Since

treatment in

 

>standard professional Chinese medicine is ultimately predicated on

pattern

 

>discrimination (bian zheng lun zhi), the information we need to

gather

to

 

>plan our treatments is only that information necessary to confirm or

deny a

 

>pattern discrimination (also given the fact that most of our

patient's

have

 

>5-10 patterns SIMULTANEOUSLY). This does not require anything more

than the

 

>28 pulses. In fact, methodologically, this process cannot currently

 

>accomodate anything more than the 28 pulse and 10 death pulses. (To

 

>accomodate more pulse images, we would have to redefine the

" standard "

 

>signs and symptoms of our " standard " patterns.)

 

>

 

>If one has 5-10 patterns presenting simultaneously, the trick is not

to

 

>feel some arcane, esoteric pulse but to interpret what a specific

 

>combination of pulse images mean in a particular patient at a

particular

 

>moment in time. For instance, let's say the patient has the following

pulse

 

>images:

 

>

 

>Speed: slightly fast, 90 bpm

 

>

 

>Rt:

 

>Inch: Vacuous

 

>Bar: Soggy, slightly slippery on pressing and searching

 

>Cubit: Slippery, bowstring, and deep, but only normally deep, not

 

>abnormally deep

 

>

 

>Lft:

 

>Inch: Soggy

 

>Bar: floating, bowstring & fine

 

>Cubit: floating, bowstring & fine

 

>

 

>This is a real-life pulse picture taken from my patient files. Even

without

 

>the corroborating general signs and symptoms and tongue signs, we can

say

 

>the following things about the patient's probable patterns (which we

then

 

>could easily corroborate by those signs and symptoms and tongue

signs):

 

>

 

>The right bar soggy pulse tells us there is a spleen qi vacuity with

 

>probably engenderment of dampness and the spleen not engendering and

 

>transforming the blood. The left bar position tells us there is liver

 

>depression qi stagnation at least in part associated with blood and

yin not

 

>nourishing and moistening the liver. The fact that the right bar is

 

>slightly bowstring on pressing and searching tells us the liver is

invading

 

>the spleen. So now we know there is a liver-spleen disharmony.

 

>

 

>The right cubit position tells us that there is dampness and probably

heat

 

>in the lower burner (due to spleen vacuity). the sligfhtly rapid

pulse

 

>tells us there is some sort of evil heat, probably vacuity but

definitely

 

>associated with vacuity. The left cubit position tells us that there

is

 

>kidney yin vacuity. (Now we know there is dual liver-kidney yin

vacuity).

 

>

 

>The floating images in the inch positions further confirm there is

yin

 

>vacuity (yin not controlling yang which is counterflowing upward).

The

 

>right inch suggests that the lung qi is also vacuous due to a

probable

 

>combination of A) the heat of damp heat below ascending to collect in

the

 

>lungs and consume the qi and B) spleen vacuity not upbearing the

clear

to

 

>form the ancestral or chest qi. The left inch suggests that the heart

 

>spirit is not being constructed and nourished properly, and so there

are

 

>probably symptoms of the spirit not being quiet or calm.

 

>

 

>>From here you need to have a good grasp of advanced Chinese medical

theory.

 

>Since the bowstring pulse suggests that the qi is not flowing freely,

 

>especially in the lower part of the body, we might expect menstrual

or

 

>reproductive pain in females and/or damp heat urinary or impediment

 

>problems in both males and females. Because the qi moves the blood

and

 

>because of the interrelationships of the six depressions (liu yu), qi

 

>stagnation may have given rise to blood stasis, but we may have to

confirm

 

>this by one of our other streams of information, NOT the pulse.

Further,

 

>since damp heat may cause ministerial fire to stir or counterflow

upward,

 

>thus leaving its lower source vacuous and cold, there may be kidney

yang

 

>vacuity below which also does not manifest in the pulse but which

must

be

 

>confirmed or denied by other streams of information, such as

questioning.

 

>Because of the interrealtionship between former and latter heavens,

 

>long-standing spleen vacuity may easily lead to kidney yang vacuity.

Sex

 

>and age will also play their part in determining the presence of such

yang

 

>vacuity which commonly does NOT manifest in the pulse because the

pulse is

 

>located in the upper part of the body and heat (which is yang)

inherently

 

>travels upward. Another way to explain this is to say that the pulse

is

 

>ruled by the heart (xin zhu mai) and the heart is in the upper part

of

the

 

>body. In either case, in most cases of yang vacuity in our patients,

yang

 

>vacuity does not manifest as a slow, deep pulse. In fact, it only

manifests

 

>in the pulse at all by indirect inference, not direct image.

 

>

 

>This process has its own complexity, but it is not the complexity of

some

 

>supernormal dexterity, mystical intuition, or esoteric knowledge. It

has to

 

>do with 1) feeling relatively easy to distinguish feelings, 2)

labelling

 

>these feelings, and then 3) interpreting these feelings correctly

when

 

>taken as a total gestalt.

 

>

 

>In terms of the pulse example above, this patient's patterns are: 1)

a

 

>liver-spleen disharmony (this is an abbreviation for saying A) liver

 

>depression qi stagnation and B) spleen qi vacuity weakness, 2) dual

 

>liver-kidney yin vacuity (with possible yang vacuity yet to be

 

>established), 3) probably damp heat impediment complicated by 4)

 

>malnourishment of the sinews, 5) possible blood stasis, and 6)

lung-heart

 

>vacuity at the very least. Since a lung qi vacuity is as good as

saying a

 

>defensive qi vacuity, this person is easily susceptible to external

 

>invasion. So the presence of external evils lodged in the exterior

(7)

 

>would also have to be considered.

 

>

 

>Capisce?

 

>

 

>Bob

 

>

 

>> [Original Message]

 

>> HappyHerbalist.com <<Health

 

>> <

 

>> 05/21/2000 5:18:48 PM

 

>> RE: pulses

 

>>

 

>> Those are the only pulses and details in 98% of the clinical

cases

 

>> that I encountered while attending clinic rounds at Five Branches

(Santa

 

>> Cruz, CA.) the Oriental Heath Sciences Academy (Oakland,CA. -

sorry I

 

>seem

 

>> to have forgotten their name)and the now defunct San Francisco

College of

 

>> Acupuncture. All my clinical teachers were from Taiwan or Shanghai.

My

 

>> tutorial teacher (Dr Wu from Tianjin, China) was better with more

nuances,

 

>> like Kidney Yang Floating and would bring me in to feel any unusual

 

>pulses.

 

>> But again in his diagnosis for me would give only the main pulse

sign. The

 

>> tongue played a prominent role. BTW he's and excellent herbalist.

 

>>

 

>> My 5 element friends all know pulses far far better than I -

except

they

 

>> don't know herbs.

 

>>

 

>> <<<<snipped>> The vast majority of instances I found were for three

 

>qualities:

 

>>

 

>> 1. slippery in the spleen position

 

>>

 

>> 2. wiry in the liver position

 

>>

 

>> 3. weak in the kidney position

 

>>

 

>> Ed Kasper L.Ac., Santa Cruz, California

 

>>

 

>>

 

>>

----

--

 

>> Missing old school friends? Find them here:

 

>> http://click./1/4055/9/_/542111/_/958951117/

 

>>

----

--

 

>>

 

>> Chronic Diseases Heal - Chinese Herbs Can Help

 

>>

 

>

 

>

 

>

 

>--- Robert Flaws

 

>--- bobflaws

 

>--- EarthLink: It's your Internet.

 

>

 

>

 

>

 

>---

---

 

>Missing old school friends? Find them here:

 

>http://click./1/4055/9/_/542111/_/959024080/

 

>---

---

 

>

 

>Chronic Diseases Heal - Chinese Herbs Can Help

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One has to remember that a large majority of American practitioners of

Chinese medicine practice both acumoxatherapy and herbal medicine, for

better or for worse. I know my practice is about 50/50. It is my opinion

that a channel-based acupuncture, rooted in the Nan Jing and other

acupuncture texts, is more effective than TCM acupuncture in many

circumstances. Therefore, knowledge of Nan Jing pulses becomes essential

for clinical practice of effective acupuncture. Also, the 28 pulse

qualities, as you know, have different and more specific meanings in

different positions and clinical situations.

 

Another great translated classic on pulses (from Blue Poppy) is " Master

Hua's Classic of the Central Viscera " . Lots of rich detail.

 

 

>

 

>It is my observation, however, that the herbal texts I am familiar with

>place little or no emphasis on nan jing style 12 position pulse dx. The

>majority of the time, pulse is described in general terms like wiry,

>deep or slippery, without regard to position in terms of cun , guan and

>chi positions. This is true whether we are talking about classics like

>zhu dan xi, basics like Fundamentals of CM or advanced internal

>medicine, like Philippe sionneau's Tx of Dz in TCM. In some cases,

>reference is made to position, but this is fairly circumscribed. The

>vast majority of instances I found were for three qualities:

>

>1. slippery in the spleen position

>

>2. wiry in the liver position

>

>3. weak in the kidney position

>

>Clinical use of the nanjing positions for SI, PC, TB, LI, BL in herbal

>texts is even rarer and never mainstream, as far as I can tell. While

>these very systematized ideas from acupuncture theory were toyed with

>during the jin-yuan, according to Unschuld, they ultimately never took

>hold among most herbalists. Li shi zhen certainly discussed cun, guan

>and chi in every chapter of his pulse classic, but it is worth noting

>that this work was a later attempt to systematize all prior knowledge

>and perhaps did not necessarily reflect actual practice through much of

>Chinese history.

>

>As to the 28 general pulses of Li shi zhen, I can only observe that most

>of the clinically meaningful information seems to be connected to

>combinations of fairly straightforward qualities, such as

>floating/sinking, slippery/choppy, xu/shi, fast/slow and wiry/tight.

>this would lend support to Flaws contention that the main clinical skill

>in pulse dx for an herbalist is memorizing these combinations and

>relationships.

>

>Pragmatically, I'm not sure what role any additional nuancing in pulse

>dx would play in my selection of herbs. However, the relationship

>between nanjing style pulsetaking and acumoxatherapy is certainly a

>different story altogether, one I can't really comment upon at all.

>

>Todd

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Z'ev,

 

I was only talking about Chinese pulse examination since the late Ming. In

standard professional Chinese medicine as practice in the PRC, this system

is used in the acupuncture, tui na, and internal medicine departments. In

my experience, it works fine for acupuncture. However, if you think the Nan

Jing system of pulse examination is better for acupuncture, I have no

problem with that. It all depends on your style of acupuncture and how you

plan and implement treatment.

 

Bob

 

 

> [Original Message]

> <zrosenberg

>

> 05/22/2000 5:02:40 PM

> RE: pulses

>

> As usual, I enjoy the clarity of Bob's material and points of view. He

> has expressed very important information in this posting in a practical

> and condensed manner.

>

>

> For myself, however, I would like to point out that in my practice that

> I do see a lot of unusual pulses, especially se mai/scattered pulses,

> as well as the scallion-stalk and water dripping pulses. This may be

> because of the number of patients I see with cancer or lupus, who are

> undergoing chemotherapy and/or radiation and other strong biomedical

> treatments. So it is important that we teach and share them. Many of

> our students at PCOM are doing their clinical intership at a hospice,

> and see these pulses weekly.

>

>

> Also, for practitioners of acupuncture, learning Nan Jing pulse

> techniques is essential; the pulse qualities that Bob describes are

> <italic>largely</italic> connected with internal, i.e. Chinese herbal

> medicine. I think Jim Ramholz emphasizes Nan Jing pulses in his work.

> However, the expression needs to be clarified. Without access to

> Wiseman translation terminology, pulse images become obscured and

> difficult to communicate.

>

>

>

>

>

>

>

> >Given the nature of our out-patient clientele, their lifestyles, age,

> sex,

>

> >and the kinds of problems that we are primarily called on to treat,

> only

>

> >approximately half of the 28 pulse images present on a day in/day out

> basis

>

> >(at least in terms of mainstream Chinese pulse diagnosis as practiced

> since

>

> >the late 16th century on the Mainland). In my experience, these are:

>

> >

>

> >1. Slippery

>

> >2. Bowstring

>

> >3. Fine

>

> >4. Soggy

>

> >5. Floating

>

> >6. Deep

>

> >7. Fast

>

> >8. Slow

>

> >9. Moderate (i.e., slightly slow)

>

> >10. Knotted

>

> >11. Intermittent

>

> >12. Vacuous

>

> >13. Short (meaning the pulse does not reach into the inch position)

>

> >

>

> >Some of these are already compound pulses (i.e., pulse images made up

> of

>

> >elements of one or more simpler pulse images). For instance, the

> soggy

>

> >pulse is floating, fine, and forceless. The vacuous pulse is

> floating,

>

> >large (i.e., wide), and forceless. In addition, most of the rest of

> the 28

>

> >are only more extreme variations of these core 13. For instance, the

> faint

>

> >pulse is only very, very fine and forceless. The weak pulse is only

> deep,

>

> >slow, and forceless. The hidden pulse is only very, very deep, and

> not

>

> >particularly forceful, etc. If one memorizes these definitions, these

> other

>

> >pulses are not at all difficult to feel and identify when they happen

> to

>

> >appear.

>

> >

>

> >Some of the other 28 pulses are so extreme that we just don't see them

> in

>

> >our mostly out-patient, " walking wounded, " chronic disease settings.

> If you

>

> >want to feel the scallion-stalk, racing, water-dripping, shrimp

> swimming

>

> >pulses, you need to ride in an ambulance, work in the ER or in ICU. Or

> you

>

> >need to hang out with patients in hospices.

>

> >

>

> >Otherwise, in our clinical practice in the U.S. and Europe, the key

> trick

>

> >is not to feel and distinguish the pulse images that tend to repeat

> over

>

> >and over again (that's relatively easy!), but to interpret what these

> pulse

>

> >images mean when they show up in combination in the different

> positions.

>

> >

>

> >One of my Chinese teachers in Shanghai in 1982 pleaded with me not to

>

> >mystify myself. If took me another half dozen years to understand and

>

> >ACCEPT what she was trying to tell me. I was so biased by my

> orientialist

>

> >romanticism, I just couldn't let her advice based on 20 years of

> experience

>

> >in. My cup was too full. I suspect my advice is going to fall on a lot

> of

>

> >deaf ears. It certainly has in the past. But I think I do understand

> where

>

> >a lot of us are coming from since I came from exactly the same place

> or

>

> >even more so. Please, as a profession, let's not over-mystify pulse

>

> >examination.

>

> >

>

> >This is a general tendency many of us have within this profession, and

> my

>

> >experience is that this tendency is even more pronounced when it comes

> to

>

> >the pulse. It is so easy for charlatans (even in China) to bamboozle

> the

>

> >uninitiated about this. This is exactly why Zhang Jing-yue, one of

> the

>

> >greatest medical thinkers and writers of his day (late Ming) said

> that

>

> >pulse examination should come AFTER looking and questioning. In order

> to

>

> >emphasize the role of questioning and de-romanticize, de-mystify the

> pulse,

>

> >he authored the 10 Questions.

>

> >

>

> >We don't need to make this method of examination any more difficult

> than it

>

> >is. A pattern (zheng) is made up of the convergence and corroboration

> of

>

> >three streams of information based on the Four Examinations: 1)

> general

>

> >signs and symptoms, 2) tongue signs, and 3) pulse signs. Since

> treatment in

>

> >standard professional Chinese medicine is ultimately predicated on

> pattern

>

> >discrimination (bian zheng lun zhi), the information we need to gather

> to

>

> >plan our treatments is only that information necessary to confirm or

> deny a

>

> >pattern discrimination (also given the fact that most of our patient's

> have

>

> >5-10 patterns SIMULTANEOUSLY). This does not require anything more

> than the

>

> >28 pulses. In fact, methodologically, this process cannot currently

>

> >accomodate anything more than the 28 pulse and 10 death pulses. (To

>

> >accomodate more pulse images, we would have to redefine the

> " standard "

>

> >signs and symptoms of our " standard " patterns.)

>

> >

>

> >If one has 5-10 patterns presenting simultaneously, the trick is not

> to

>

> >feel some arcane, esoteric pulse but to interpret what a specific

>

> >combination of pulse images mean in a particular patient at a

> particular

>

> >moment in time. For instance, let's say the patient has the following

> pulse

>

> >images:

>

> >

>

> >Speed: slightly fast, 90 bpm

>

> >

>

> >Rt:

>

> >Inch: Vacuous

>

> >Bar: Soggy, slightly slippery on pressing and searching

>

> >Cubit: Slippery, bowstring, and deep, but only normally deep, not

>

> >abnormally deep

>

> >

>

> >Lft:

>

> >Inch: Soggy

>

> >Bar: floating, bowstring & fine

>

> >Cubit: floating, bowstring & fine

>

> >

>

> >This is a real-life pulse picture taken from my patient files. Even

> without

>

> >the corroborating general signs and symptoms and tongue signs, we can

> say

>

> >the following things about the patient's probable patterns (which we

> then

>

> >could easily corroborate by those signs and symptoms and tongue

> signs):

>

> >

>

> >The right bar soggy pulse tells us there is a spleen qi vacuity with

>

> >probably engenderment of dampness and the spleen not engendering and

>

> >transforming the blood. The left bar position tells us there is liver

>

> >depression qi stagnation at least in part associated with blood and

> yin not

>

> >nourishing and moistening the liver. The fact that the right bar is

>

> >slightly bowstring on pressing and searching tells us the liver is

> invading

>

> >the spleen. So now we know there is a liver-spleen disharmony.

>

> >

>

> >The right cubit position tells us that there is dampness and probably

> heat

>

> >in the lower burner (due to spleen vacuity). the sligfhtly rapid

> pulse

>

> >tells us there is some sort of evil heat, probably vacuity but

> definitely

>

> >associated with vacuity. The left cubit position tells us that there

> is

>

> >kidney yin vacuity. (Now we know there is dual liver-kidney yin

> vacuity).

>

> >

>

> >The floating images in the inch positions further confirm there is

> yin

>

> >vacuity (yin not controlling yang which is counterflowing upward).

> The

>

> >right inch suggests that the lung qi is also vacuous due to a

> probable

>

> >combination of A) the heat of damp heat below ascending to collect in

> the

>

> >lungs and consume the qi and B) spleen vacuity not upbearing the clear

> to

>

> >form the ancestral or chest qi. The left inch suggests that the heart

>

> >spirit is not being constructed and nourished properly, and so there

> are

>

> >probably symptoms of the spirit not being quiet or calm.

>

> >

>

> >>From here you need to have a good grasp of advanced Chinese medical

> theory.

>

> >Since the bowstring pulse suggests that the qi is not flowing freely,

>

> >especially in the lower part of the body, we might expect menstrual

> or

>

> >reproductive pain in females and/or damp heat urinary or impediment

>

> >problems in both males and females. Because the qi moves the blood

> and

>

> >because of the interrelationships of the six depressions (liu yu), qi

>

> >stagnation may have given rise to blood stasis, but we may have to

> confirm

>

> >this by one of our other streams of information, NOT the pulse.

> Further,

>

> >since damp heat may cause ministerial fire to stir or counterflow

> upward,

>

> >thus leaving its lower source vacuous and cold, there may be kidney

> yang

>

> >vacuity below which also does not manifest in the pulse but which must

> be

>

> >confirmed or denied by other streams of information, such as

> questioning.

>

> >Because of the interrealtionship between former and latter heavens,

>

> >long-standing spleen vacuity may easily lead to kidney yang vacuity.

> Sex

>

> >and age will also play their part in determining the presence of such

> yang

>

> >vacuity which commonly does NOT manifest in the pulse because the

> pulse is

>

> >located in the upper part of the body and heat (which is yang)

> inherently

>

> >travels upward. Another way to explain this is to say that the pulse

> is

>

> >ruled by the heart (xin zhu mai) and the heart is in the upper part of

> the

>

> >body. In either case, in most cases of yang vacuity in our patients,

> yang

>

> >vacuity does not manifest as a slow, deep pulse. In fact, it only

> manifests

>

> >in the pulse at all by indirect inference, not direct image.

>

> >

>

> >This process has its own complexity, but it is not the complexity of

> some

>

> >supernormal dexterity, mystical intuition, or esoteric knowledge. It

> has to

>

> >do with 1) feeling relatively easy to distinguish feelings, 2)

> labelling

>

> >these feelings, and then 3) interpreting these feelings correctly

> when

>

> >taken as a total gestalt.

>

> >

>

> >In terms of the pulse example above, this patient's patterns are: 1)

> a

>

> >liver-spleen disharmony (this is an abbreviation for saying A) liver

>

> >depression qi stagnation and B) spleen qi vacuity weakness, 2) dual

>

> >liver-kidney yin vacuity (with possible yang vacuity yet to be

>

> >established), 3) probably damp heat impediment complicated by 4)

>

> >malnourishment of the sinews, 5) possible blood stasis, and 6)

> lung-heart

>

> >vacuity at the very least. Since a lung qi vacuity is as good as

> saying a

>

> >defensive qi vacuity, this person is easily susceptible to external

>

> >invasion. So the presence of external evils lodged in the exterior

> (7)

>

> >would also have to be considered.

>

> >

>

> >Capisce?

>

> >

>

> >Bob

>

> >

>

> >> [Original Message]

>

> >> HappyHerbalist.com <<Health

>

> >> <

>

> >> 05/21/2000 5:18:48 PM

>

> >> RE: pulses

>

> >>

>

> >> Those are the only pulses and details in 98% of the clinical

> cases

>

> >> that I encountered while attending clinic rounds at Five Branches

> (Santa

>

> >> Cruz, CA.) the Oriental Heath Sciences Academy (Oakland,CA. -

> sorry I

>

> >seem

>

> >> to have forgotten their name)and the now defunct San Francisco

> College of

>

> >> Acupuncture. All my clinical teachers were from Taiwan or Shanghai.

> My

>

> >> tutorial teacher (Dr Wu from Tianjin, China) was better with more

> nuances,

>

> >> like Kidney Yang Floating and would bring me in to feel any unusual

>

> >pulses.

>

> >> But again in his diagnosis for me would give only the main pulse

> sign. The

>

> >> tongue played a prominent role. BTW he's and excellent herbalist.

>

> >>

>

> >> My 5 element friends all know pulses far far better than I - except

> they

>

> >> don't know herbs.

>

> >>

>

> >> <<<<snipped>> The vast majority of instances I found were for three

>

> >qualities:

>

> >>

>

> >> 1. slippery in the spleen position

>

> >>

>

> >> 2. wiry in the liver position

>

> >>

>

> >> 3. weak in the kidney position

>

> >>

>

> >> Ed Kasper L.Ac., Santa Cruz, California

>

> >>

>

> >>

>

> >>

> ------

>

> >> Missing old school friends? Find them here:

>

> >> http://click./1/4055/9/_/542111/_/958951117/

>

> >>

> ------

>

> >>

>

> >> Chronic Diseases Heal - Chinese Herbs Can Help

>

> >>

>

> >

>

> >

>

> >

>

> >--- Robert Flaws

>

> >--- bobflaws

>

> >--- EarthLink: It's your Internet.

>

> >

>

> >

>

> >

>

> >------

>

> >Missing old school friends? Find them here:

>

> >http://click./1/4055/9/_/542111/_/959024080/

>

> >------

>

> >

>

> >Chronic Diseases Heal - Chinese Herbs Can Help

>

>

>

>

>

 

 

 

--- Robert Flaws

--- bobflaws

--- EarthLink: It's your Internet.

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If you are talking about Cheng Dan-an's acupuncture style, or the material

that you translated in " Sticking to the Point " Volume 2, I agree. It is a

very sophisticated approach to acupuncture, and has influenced my practice

a great deal. But most Western practitioners of TCM acupuncture have not,

seemingly, been exposed to this material.

 

 

 

 

 

>Z'ev,

>

>I was only talking about Chinese pulse examination since the late Ming. In

>standard professional Chinese medicine as practice in the PRC, this system

>is used in the acupuncture, tui na, and internal medicine departments. In

>my experience, it works fine for acupuncture. However, if you think the Nan

>Jing system of pulse examination is better for acupuncture, I have no

>problem with that. It all depends on your style of acupuncture and how you

>plan and implement treatment.

>

>Bob

>

>

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What would you (et al) advice a newly licensed Acupuncturist /herbalist -or

one with little experience in pulse diagnosis to become proficient at pulse

diagnosis ?

 

Books are excellent for groundwork and preparation (and refining skills once

one has accomplishments) yet one cannot learn from books alone

 

CEU and weekend classes are (in my opinion) superficial unless applied to a

larger structure

 

Practice and Experience are insightful yet may lead one astray.

 

In my limited experience Five Element patricitionors " speak the same

language " universally. And this successfully leads to greater dialogue,

understanding and diagnosis.

While TCM pulse takers can only communicate on a very limited scale.

 

I think this is based on the Structure of the education system not upon the

thirst of the students.

 

Thank you

Ed Kasper L.Ac., Santa Cruz, California

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Hi Ed,

 

> What would you (et al) advice a newly licensed Acupuncturist

/herbalist -or

> one with little experience in pulse diagnosis to become proficient at

pulse

> diagnosis ?

 

I'd say the first step is a recognition of its status as a component in a

rather

complex system of understanding both normal physiology as well as

diagnosis of pathogenic processes within the body. When I spent several

months apprenticing under the head of the acupuncture department at

the teaching hospital attached to the Chengdu University of TCM, Dr.

Wang must have told me ten thousand times to " look at the patient. "

We'd see twenty or thirty patients a morning, day after day, from 8:30

until noon, just doing intake interviews and diagnosing patient after

patient.

Each one began with the same admonition, as if it were the very first time

he'd said it. " You must look at the patient. " He taught me in this way

to understand that the most important thing about diagnosis was the

gathering of information, sense impressions of the person sitting in

front us.

 

With time I've come to understand that the capacity to receive information

through all the sensory channels is of fundamental importance in conducting

a proper diagnostic interview using traditional Chinese medical means. I

believe

this is one of the great treasures in the great treasure house of

traditional

Chinese medicine, this expertise in physical medicine, the ability to know

what is going on with patients by looking at them, touching them, listening

to them, smelling them, and so on. I see this aspect of the doctor/patient

interaction as being a critical aspect of Chinese medicine's recent

ascendency on the American scene. People want doctors who will

pay attention to them and to the extent that we develop such capacities,

which lie at the core of traditional Chinese clinical medicine, we can

succor a great wound that the modern medical and health care system

has administered to the citizenry.

 

It is a pretty short step to the awareness that what we are talking about

in traditional Chinese diagnostics is the development of an athletic

ability. Quite a refined, one would have to say, rarefied art. In my

personal training it has become inseparable from my decades-long

quest to cultivate the capacity to listen to an opponent (or patient)

with my whole body/mind. I refer specifically to the practice of

push-hands in taijiquan, wherein two practitioners mutually cultivate

one another's awareness and capacity to " give up yourself and

follow others. " It takes decades for true skill to emerge. It is simply

not reasonable to expect that such skill could emerge easily or early on

in one's training. Proficiency? I suggest we lower our aim, if only

to begin with. How about we design a curriculum that brings together

in one focus all the critical elements a student would have to comprehend

and be able to coordinate the use of in order to conduct a successful

diagnosis of a patient? Then we would have a proper context in

which instruction in pulse diagnosis could be realistically expected

to take place with some meaningsul result.

 

I'd put on this list:

 

-an understanding of yin/yang and qi

-a thorough grasp of jing luo, not merely the numbers of points on

channels, but a comprehensive sense of how the qi circulates

throughout the body, interconnecting it into a micro-cosm of

the whole universe

-a good grasp of zang fu theory and a working understanding

of how zang fu and jing luo interconnect and interact so that

the appearance of sensations beneath one's fingertips at the

cun, quan, chi positions has an immediate meaning, and not

merely an abstract set of correlations

-a personal practice that serves to accumulate, cultivate, and

refine one's personal qi as well as one's consciousness of qi

and it's implications

-gong fu that serves to develop one's listening power

-the opportunity to feel the pulses of hundreds of people,

both well and ill so that the information one receives can

be compared to real experience

-the guidance of a well-trained clinician who knows

both the skill of pulse diagnosis and the significance of

the data that one can develop therefrom

-access to the literary sources; and

-a good deal of patience

 

> I think this is based on the Structure of the education system not upon

the

> thirst of the students.

 

Amen.

 

This brings the correct target clearly into focus: the structure of the

education

system.

 

Ken

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  • 3 years later...
Guest guest

I agree about the need for demonstration.

>>>>Will when are we going to see a blind study then? How about a blind study of

Leon practitioner's since they all train in a similar system. This should be

easy and cheep to do you only need 30 patients or so and about 9 practitioners.

Alon

 

 

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  • 10 months later...
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Speaking of pulses - does anyone know of any CE in diagnosis happening this

year? My pulse diagnosis class at school four years ago was not sufficient,

and I have very little confidence in what I feel outside of " floating/deep " ,

" thin/thick " and " weak/strong " in various positions.

 

Benjamin Hawes, MAOM, Lic. Ac.,

 

CORTEZ FAMILY ACUPUNCTURE

1430 E. Main Street, Suite #4

Cortez, CO 81321

(970) 565-0230

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may teach this in summer, Expert Pulse Diagnosis, and the distance

learning DVD may be ready by

then. earns 5 CEUS with NCCAOM and other states. offers an easier,

non-mystical, common as

latte, view.

 

Dr. Keikobad

CEUS by DVD

www.acu-free.com

 

 

Benjamin Hawes wrote:

 

> Speaking of pulses - does anyone know of any CE in diagnosis happening

> this

> year? My pulse diagnosis class at school four years ago was not

> sufficient,

> and I have very little confidence in what I feel outside of

> " floating/deep " ,

> " thin/thick " and " weak/strong " in various positions.

>

> Benjamin Hawes, MAOM, Lic. Ac.,

> Director

>

> CORTEZ FAMILY ACUPUNCTURE

> 1430 E. Main Street, Suite #4

> Cortez, CO 81321

> (970) 565-0230

>

>

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