herbal pulses

[Guest guest]

If one surveys modern TCM clinical manuals, you can't help but notice the

absence of pulse position information in the symptom complex listings.

What I mean is that you just see qualities like fast, slow, choppy, forceful,

forceless, wiry, tight in various combinations, but rarely a mention of

something like "weak in the chi position" to signify kidney xu. The

same is largely true of formularies like Bensky (though with exceptions

to this rule). The question is how significant is twelve position

pulse taking to herbal practice. I am not asking whether it COULD

or SHOULD be useful, but whether it HAS been considered important in herbal

classics of the past and whether much use is made of it in modern China.

As usual, I want evidence, not conjecture.

--

 

Chinese Herbal Medicine

 

 

[Guest guest]

on 10/29/00 8:10 PM, Todd at wrote:

 

If one surveys modern TCM clinical manuals, you can't help but notice the absence of pulse position information in the symptom complex listings. What I mean is that you just see qualities like fast, slow, choppy, forceful, forceless, wiry, tight in various combinations, but rarely a mention of something like " weak in the chi position " to signify kidney xu. The same is largely true of formularies like Bensky (though with exceptions to this rule). The question is how significant is twelve position pulse taking to herbal practice. I am not asking whether it COULD or SHOULD be useful, but whether it HAS been considered important in herbal classics of the past and whether much use is made of it in modern China. As usual, I want evidence, not conjecture.

 

One that comes to mind immediately, is the Blue Poppy translation of Zhong zhong jing/Master Hua's Classic of the Central Viscera. This text has several prescriptions, and detailed descriptions of visceral pulses with positions emphasized.

 

 

[Guest guest]

, " " <

zrosenberg@e...> wrote:

 

>

> One that comes to mind immediately, is the Blue Poppy translation of

> Zhong zhong jing/Master Hua's Classic of the Central Viscera. This text has

> several prescriptions, and detailed descriptions of visceral pulses with

> positions emphasized.

>

>

 

I find that book to be way outside the mainstream of classical thought.

The patterns, pulse attributions and formulae don't jive with anything

else I know. the books intro suggests the material was channeled by a

taoist mystic, rather than derived through practice and study. It does

not seem to have served as an antecedent for subsequent developments in

herbology.

 

[Guest guest]

It is possible only if one is skilled at it; but I suspect there is

little real training in schools regarding pulses. If you consider the

Nan Ching material, you can read 30 positions (five levels in 6

positions). Leon Hammer's system has more than 12 positions; and my

(Korean) system has 324 basic. Except from Leon Hammer and myself, I

haven't heard any lengthy discussions about using complicated pulse

patterns to describe specific disorders (I suspect there are a few

others). My teacher, a Korean, was the only person I know to

exclusively use pulses for diagnosis.

 

When you get to that level of complexity, each disorder has a

particular " signature " in the pulses. But in order to read that level

of complexity, you have to change the terms of your discussion from 8-

Principles to 5-Elements because problems often involve the dynamic

interaction of several organs or levels. In my recent posting on

endometriosis, I gave a fairly specific description of how it looks

in both the acute and chronic stages. Like a piece of music, it's

awkward to describe, but once you feel it under your fingertip, you

will recognize it next next time it appears; often before your

patients tell you.

 

For example, in general, instead of reading " gallbladder qi vacuity, "

you should be able to see the differences---in the pulses alone---

between anxiety, insomnia, excessive dreaming, dizziness, vertigo,

nausea, vomiting, or palpations. Watching the pulse change when you

give someone an acupuncture treatment or herbal formula is an

objective measure of how you have changed their body.

 

When putting herbal formulas together and considering their effects,

I always study the changes in pulses. Often I test new formulas on my

assistant and track the changes in his pulses; and my own.

 

Jim Ramholz

 

 

 

 

 

 

 

, wrote:

> If one surveys modern TCM clinical manuals, you can't help but

notice

> the absence of pulse position information in the symptom complex

> listings. What I mean is that you just see qualities like fast,

slow,

> choppy, forceful, forceless, wiry, tight in various combinations,

but

> rarely a mention of something like " weak in the chi position " to

signify

> kidney xu. The same is largely true of formularies like Bensky

(though

> with exceptions to this rule). The question is how significant is

> twelve position pulse taking to herbal practice. I am not asking

> whether it COULD or SHOULD be useful, but whether it HAS been

considered

> important in herbal classics of the past and whether much use is

made of

> it in modern China. As usual, I want evidence, not conjecture.

>

> --

>

> Director

> Chinese Herbal Medicine

>

[Guest guest]

, " James Ramholz " <OMJournal@m...>

wrote:

Watching the pulse change when you

> give someone an acupuncture treatment or herbal formula is an

> objective measure of how you have changed their body.

>

My question still stands. Is their evidence of this use of pulse in

classical herbology practice or was positional pulse study (whether 12,

30 or 324) always somewhat divorced from the clinical practice of

herbology. I can see the connection to acupuncture, which has more

direct clinical relationship to concepts like the 12 channels and the

five elements. I think the SHL also makes some references to

positions. But this has not seemed to influence the modern use of

these formulae. In Bensky, SHL formulae, like most others, do not

include info about positions (however they often indicate differences

between left and right pulses). Bensky drew this info from the actual

source texts, so I assume if it was present, he would have included it.

 

[Guest guest]

I would side with Z'ev here regarding Master Hua. The pulse

descriptions are fairly interesting and often accurate; you have to

remember, it's like trying to describe music. But I suspect the text

was edited by someone who doesn't really know pulse diagnosis. Like

most Chinese texts, it offers poor descriptions and seem like they

were meant to impress but not truly inform. The classics, in general,

are not the final arbiter of what we can know; but they are a good

starting point from which to learn.

 

My teacher often used Hua To formulas, and I have followed in that

interest having found several books of herbal formulas in Chinese

attributed to master Hua.

 

You have to distinguish " classical " from what is now considered the

standard of Chinese medicine (what is on the AAAOM exam). What we

have is actually pretty watered down; first by the Communists and

then the Americans trying to develop and test a " common denominator. "

We don't teach much or use much classical material. The Nan Ching and

Su Wen are filled with examples of how to apply 5-Elements, but the

theory was outlawed by the communists and largely ignored by the

Americans.

 

Jim Ramholz

 

 

 

 

, " " <@i...>

wrote:

> , " " <

> zrosenberg@e...> wrote:

>

> >

> > One that comes to mind immediately, is the Blue Poppy

translation of

> > Zhong zhong jing/Master Hua's Classic of the Central Viscera.

This text has

> > several prescriptions, and detailed descriptions of visceral

pulses with

> > positions emphasized.

> >

> >

>

> I find that book to be way outside the mainstream of classical

thought.

> The patterns, pulse attributions and formulae don't jive with

anything

> else I know. the books intro suggests the material was channeled

by a

> taoist mystic, rather than derived through practice and study. It

does

> not seem to have served as an antecedent for subsequent

developments in

> herbology.

>

 

[Guest guest]

It depends on the skill of the practitioner. It is still a common

practice to go to a Chinese herbalist and watch him take your pulses

before deciding which herbal formula to give you. I saw it in Chicago

many times; and suspect it is commonly done in most Chinese

communities. Others of course behave like Western doctors, and will

prescribe according to symptomology (which is okay for simple

things). If it's in the Master Hua text, then that is sufficent

evidence that it was done during classical times, too. If they say

it's " channeled " that usually means that they don't want to tell you

how it's done in order to retain control and power.

 

And the Bensky text does include classical information about what

meridians and organs an herb influences. This is certainly intersting

and useful information to track in the pulses. I often use it to

decide what additions and subtractions are made to a formula. I don't

distinguish between an acupuncture treatment and an herbal one since

both are, in my mind, designed to change a particular pattern in the

pulses.

 

But I think you're asking a question that requires a statistical

answer. It was done, but to what degree and by whom is debateable.

How we decide to do what we do in America is more a political

decision than a theoretical one. And a practical decision since we

often follow the lead of our teachers or what is easily available.

 

when you modify an herbal formula, do you consider the taste

and meridian induction or just the function of an herb?

 

Jim Ramholz

 

 

 

, " " <@i...>

wrote:

> , " James Ramholz "

<OMJournal@m...>

> wrote:

> Watching the pulse change when you

> > give someone an acupuncture treatment or herbal formula is an

> > objective measure of how you have changed their body.

> >

> My question still stands. Is their evidence of this use of pulse

in

> classical herbology practice or was positional pulse study (whether

12,

> 30 or 324) always somewhat divorced from the clinical practice of

> herbology. I can see the connection to acupuncture, which has more

> direct clinical relationship to concepts like the 12 channels and

the

> five elements. I think the SHL also makes some references to

> positions. But this has not seemed to influence the modern use of

> these formulae. In Bensky, SHL formulae, like most others, do not

> include info about positions (however they often indicate

differences

> between left and right pulses). Bensky drew this info from the

actual

> source texts, so I assume if it was present, he would have included

it.

>

 

[Guest guest]

, " James Ramholz " <OMJournal@m...>

wrote:

 

>

> when you modify an herbal formula, do you consider the taste

> and meridian induction or just the function of an herb?

>

> Jim Ramholz

>

 

First, when I referred to Bensky, I was not referring to his materia

medica, but his formulary. I said the formualry does typically

describe pulses according to position, but merely gives genral

qualities overall. I teach materia medica using bensky as source text

and am well aware of his listing of entering channels and tastes for

each herb. Since I own a 1986 edition, I have also discovered that

Bensky's attribution of taste and entering channel is not always the

same in the 1998 edition. Which brings up the point that these are

considered debatable points and always have been. According to

Unschuld, chinese herbology developed as an empricial pragmatic

medicine, mostly amongst taoists until the song dynasty. During the

song, neo-confucians began the process of intereting herbology within

the context of systematic correspondence from the nei jing. They had

zhang zhong jings example of bianzheng in the SHL and the shennong ben

cao, which listed flavors of 365 herbs, but no entering channels plus a

huge body of empirical prescription manuals and materia medica to draw

from.

 

they were basically in the same place we are today when considering

how to categorize western herbs or pharmaceuticals according to TCM.

During this period, many ideas arose, some of which took root amongst

the mainstream of chinese medical practice by the mid qing dynasty and

others which faded away. I suspect that many herbalists maintained a

core of that initial taoist pragmatism that eschewed

overintellectualizing the practice of medicine. So detailed

descriptions of the precise amount of yin and yang in each herb never

attained any position in clinical manuals, yet were were apparently

very prominent in theoretical texts of the song, jin and yuan. It was

at this time that channel attribution was begun. It is a subject that

still remains contested today. Different materia medicas agree on some

points but vary on others.

 

I think perhaps many theoretical tracts on pulse were also written in

chinese history, but only the most pragmatic ideas were incorporated

into mainstream clinical herbal practice by the mid qing (late 1700's).

Whether this means these ideas were not found clinically useful or were

dismissed a priori for philosophical reasons, cannot say. I just think

this is the case. If they were dismissed a priori, then perhaps they

deserve a second look. I am content with practicing herbalism as it

evolved in the mainstream of chinese society, whatever the reasons for

this. I find it to be clinically effective and thus have no motive to

experiment.

 

As to the question you actually asked me, I think the functions of

herbs incorporate any relevant clinical information contained in the

separate listings of flavors and channels. So I understand that spicy

herbs disperse and sweet supplement and bitter drain, but these are

only of interest to the extent that herbs with these flavors have

related functions. For example, I know chai hu disperses liver qi and

resolves shaoyang heat disease which informs me that chai hu affects

the liver and shaoyang channels, that it is cool, that it may be spicy.

That it raises the yang qi tells me about is direction, which also

interests me. But it is of no other concern to me that chai hu enters

the liver or is spicy. I don't use this knowledge to infer functions

not already in evidence from some reliable source, nor do I use flavors

to affect five phase dynamics, if that's what you are asking? The fact

that spicy herbs often can cause dryness or ascendant yang does

interest me for clinical purposes. I also consider knowing temperature

to be vital.

 

But as a pragmatist, I agree with Flaws in his 260 medicinals that

function and indications take clinical precedence over the channels and

flavors. And that functions are what herbs do in theory, while

indications are what herbs have been shown to do in actuality. But TCM

functions are admittedly relatively modern standardizations, so I do

not rule out the possibility that continued exploration in this area

may yield new insights. for instance, the attribution of chai hu as

the key herb for shaoyang syndromes in the SHL has led to the use of

formulae like xiao chai hu tang for inguinal swelling (as the liver,

the yin pair of the shaoyang gallbladder runs through that area-

Fruehauf) and for lymph swelling on the sides of the neck (as shaoyang

controls the sides of the body-Fruehauf). I have found chai hu seems

to be clinically effective for certain kinds of onesided throat and ear

pain, which seems to follow this logic. I find this information can

add nuance and insight to diffcult cases, but it that my mental

machinations in this area are only sometimes valid (for every insight

that works, there are several that don't). So I start with what I

consider tried and true before I move to the margins. I was born in

the year of the rabbit, if that explains anything. I hope that answers

your question.

[Guest guest]

on 10/29/00 9:13 PM, at wrote:

 

> , " James Ramholz " <OMJournal@m...>

> wrote:

> Watching the pulse change when you

>> give someone an acupuncture treatment or herbal formula is an

>> objective measure of how you have changed their body.

>>

> My question still stands. Is their evidence of this use of pulse in

> classical herbology practice or was positional pulse study (whether 12,

> 30 or 324) always somewhat divorced from the clinical practice of

> herbology. I can see the connection to acupuncture, which has more

> direct clinical relationship to concepts like the 12 channels and the

> five elements. I think the SHL also makes some references to

> positions. But this has not seemed to influence the modern use of

> these formulae. In Bensky, SHL formulae, like most others, do not

> include info about positions (however they often indicate differences

> between left and right pulses). Bensky drew this info from the actual

> source texts, so I assume if it was present, he would have included it.

>

 

>

 

 

I had an e-mail discussion with Michael Broffman a few weeks ago, in which

he basically felt that the Nan Jing tradition had gotten short shrift in

China, and that such figures as Zhang Ji (Shang Han Lun) and Li Shih-zhen

had simplified and buried the nuances of pulse diagnosis. He compared it to

the difference between " sampled electronic dance music " and the kind of

blues that Robert Johnson used to play. Interesting, at the very least. I

intend to continue this discussion with Michael at some point over tea and

the Prince of Wales' organic oat biscuits.

 

More to the point, Paul Unschuld has mentioned in his work and interviews

that the Nan Jing has been reduced in modern TCM to a commentary on the Nei

Jing, rather than a classic in its own right. It is not taught as a major

classic in the Chinese colleges, to my knowledge (Ken Rose, correct me if I

am wrong). This is not true in Japan, where study continues to this day,

and there are several commentaries in recent years. When I asked Michael

about this, he said that the number of commentaries, both high and poor

quality, had built up so much over the years, that the Chinese no longer

wanted to deal with the text.

 

I believe one reason Unschuld translated the Nan Jing was to help rescue it

from obscurity.

 

 

 

 

[Guest guest]

, " " <

>

that such figures as Zhang Ji (Shang Han Lun) and Li Shih-zhen

> had simplified and buried the nuances of pulse diagnosis.

>

 

But perhaps they did this because they were motivated by a taoist

pragmatism over a confucian rationalism. One could turn this on its

head and say others have made theoretical nuance of a subject far

beyong any useful clinical applications.

 

[Guest guest]

on 10/29/00 8:31 PM, at wrote:

 

> , " " <

> zrosenberg@e...> wrote:

>

>>

>> One that comes to mind immediately, is the Blue Poppy translation of

>> Zhong zhong jing/Master Hua's Classic of the Central Viscera. This text has

>> several prescriptions, and detailed descriptions of visceral pulses with

>> positions emphasized.

>>

>>

>

> I find that book to be way outside the mainstream of classical thought.

> The patterns, pulse attributions and formulae don't jive with anything

> else I know. the books intro suggests the material was channeled by a

> taoist mystic, rather than derived through practice and study. It does

> not seem to have served as an antecedent for subsequent developments in

> herbology.

>

 

 

Although the translation is difficult, and there is no commentary with it, I

don't agree with you about its content. I find the pulse material very

similar to what is in the Nan Jing, jives with clinical reality, and is very

astute on the 'death pulses'. Michael Broffman taught me that death pulses

has to do with channels and viscera, not necessarily the death of the

patient. Many of our very ill patients are missing certain pulses. . .for

example, I have one patient whose R kidney shriveled up and 'died' as a

result of a complication from intestinal tuberculosis, and the R chi

position pulse has subsequently 'disappeared', and never reappeared in two

years of weekly examination. Another patient's lower jiao cun pulses almost

expired after hysterectomy.

 

The introduction of the English text also states that this book is

considered to be an essential classic in China at this time. There must be

some reason for it. There are real gems in this text, don't rule it

out. And some of the prescriptions are great.. . . .I've tried a few in

clinical practice.

 

 

[Guest guest]

>

> But perhaps they did this because they were motivated by a taoist

> pragmatism over a confucian rationalism. One could turn this on its

> head and say others have made theoretical nuance of a subject far

> beyong any useful clinical applications.

>

 

>

Nope.

 

The acupuncture traditions of Japan are more than enough useful clinical

application, also adaptations in Korean medicine as well. Again, what

I learned from Michael Broffman, who largely is based in Nan Jing study,

vis-a-vis pulses, acupuncture treatment AND herbal medicine has greatly

enriched my practice. Also what I have read and (briefly) studied from Sung

Baek, and Kiko Matsumoto, Claude Larre, and others.

 

 

[Guest guest]

The larger question is how do WE utilize this material and

incorporate it into our practices and our culture.

 

For example, how much do pulses and pharmacological information

change the way you choose or modify an herbal formula?

 

Alon? Todd? Z'ev?

 

Jim Ramholz

 

 

, " "

<zrosenberg@e...> wrote:

>

> >

> > But perhaps they did this because they were motivated by a taoist

> > pragmatism over a confucian rationalism. One could turn this on

its

> > head and say others have made theoretical nuance of a subject far

> > beyong any useful clinical applications.

> >

>

> >

> Nope.

>

> The acupuncture traditions of Japan are more than enough useful

clinical

> application, also adaptations in Korean medicine as well.

Again, what

> I learned from Michael Broffman, who largely is based in Nan Jing

study,

> vis-a-vis pulses, acupuncture treatment AND herbal medicine has

greatly

> enriched my practice. Also what I have read and (briefly) studied

from Sung

> Baek, and Kiko Matsumoto, Claude Larre, and others.

>

>

[Guest guest]

(whether 12, 30 or 324)

>>>>I am willing to wager my home that no two people will agree on 1 patient 324 pulses are you? Lets do it

alon

[Guest guest]

Bensky text does include classical information about what meridians and organs an herb influences.

>>>I believe this information is not very old

alon

[Guest guest]

.. But TCM functions are admittedly relatively modern standardizations, so I do not rule out the possibility that continued exploration in this area may yield new insights. for instance, the attribution of chai hu as the key herb for shaoyang syndromes in the SHL has led to the use of formulae like xiao chai hu tang for inguinal swelling (as the liver, the yin pair of the shaoyang gallbladder runs through that area-Fruehauf) and for lymph swelling on the sides of the neck (as shaoyang controls the sides of the body-Fruehauf). I have found chai hu seems to be clinically effective for certain kinds of onesided throat and ear pain, which seems to follow this logic. I find this information can add nuance and insight to diffcult cases, but it that my mental machinations in this area are only sometimes valid (for every insight that works, there are several that don't). So I start with what I consider tried and true before I move to the margins. I was born in the year of the rabbit, if that explains anything. I hope that answers your question. >>>I agree

alon

 

 

 

eGroups Sponsor

[Guest guest]

, Z'ev wrote:

 

> >

> > The acupuncture traditions of Japan are more than enough useful

> clinical

> > application,

 

gee, I thought I was talking about pulses in herbal practice and even

said that I see the applicability in acupuncture. As to Michael

Broffman, he has chosen not to put his insights in print for all of us

to ponder, so what can I say?

 

todd

[Guest guest]

For example, how much do pulses and pharmacological information change the way you choose or modify an herbal formula?>>>>Very true

alon

[Guest guest]

on 10/30/00 7:58 AM, at wrote:

 

> , Z'ev wrote:

>

>>>

>>> The acupuncture traditions of Japan are more than enough useful

>> clinical

>>> application,

>

> gee, I thought I was talking about pulses in herbal practice and even

> said that I see the applicability in acupuncture. As to Michael

> Broffman, he has chosen not to put his insights in print for all of us

> to ponder, so what can I say?

>

> todd

>

>

I must add,

that since there are practitioners like Broffman who do use nan jing

pulse diagnosis and apply them to herb formulas, traditions or literature

must exist. . . .but at our early stage of development in the West, these

sources may only be available to us in such form as individual

practitioners. I simply do not have english language resources to rely on.

That doesn't mean we should automatically rule this out.

 

 

[Guest guest]

Dear Colleagues:

 

There are herbal pulse references in the Wang Shuhe's Mai Jing, Blue Poppy 1997.

 

The practice of medicine requires courage to create possibilities from the

classics........I believe this is what Sung Baek and John Shen (Leon Hammer's

teacher) have done. It is critical that classical works are subjected to

clinical scrutiny in order to establish the veracity of

the writings for these times. The reverse is also an important discipline. The

Nan Jing is clearly not an herbal text per se, it does give specific details

regarding acupuncture. The beautiful thing about these texts is they are open

for interpretation and lend themselves to

creative clinical application.

 

The teaching and communication of deeper and more sophisticated levels of pulse

diagnosis is no easy task, it cannot be done in large groups of people rendering

it an expensive, painful, and time consuming process. It must be done in direct

transmission from master to student. I

believe these are some of the reasons detailed material is not found in

mainstream texts. And...it is also the reason most texts use reductionist terms

to describe a most exquisite feedback system capable of profound detail. In

addition, there is no way to capture the full nuances

of the pulse given the current state of nomenclature.

 

My experience having followed the Shen-Hammer tradition for the last 10 years is

the detail available for herbal prescribing is greater with pulse analysis that

goes beyond simple mainstream notions. It is obvious, if there is deeper

insight, the possibilities are greater.

 

Furthermore there are assumptions that have been propagated for millennia that

are simply not true, such as the notion that a slippery pulse is 'normal' or a

product of Damp, I have the experience of identifying a fatty meal consumed the

day before when the blood depth is slippery

in the left Guan position (fats congealing into the portal vein disturbing blood

flow), or a slippery sensation in the radial portion of the left Cun revealing a

mitral valve prolapse. The issues revolve around the assumed interpretations for

various sensations, the capacity to

describe these phenomena. The herbal strategies for these two phenomena are

strikingly different, and one implies Damp while the other does not. As I say to

my students, question what you are being taught.

 

To quote Dennis Miller: " it's just my opinion, I could be wrong "

 

Sincerely, Will Morris

 

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[Guest guest]

The teaching and communication of deeper and more sophisticated levels of pulse diagnosis is no easy task, it cannot be done in large groups of people rendering it an expensive, painful, and time consuming process. It must be done in direct transmission from master to student. Ibelieve these are some of the reasons detailed material is not found in mainstream texts. And...it is also the reason most texts use reductionist terms to describe a most exquisite feedback system capable of profound detail. In addition, there is no way to capture the full nuancesof the pulse given the current state of nomenclature.>>>>I believe Leon is working on a book for eastland press

alon

[Guest guest]

This demonstrates fundamental

> logical assumptions that must drive clinicl thinking and

> construction of treatment plans.

>>>>>>>>>>>>and if the pulse is different and Bo He wan is still helpful is it

not food stag

alon

 

Yes.....it is, the question arising for me at this point is: why doesn't the

pulse reflect the condition? The reasons could be many from insufficiencies to

compensting mechanisms to other processes dominating the landscape. But, the

point is that it is entirely possible to localize herbal therapy according to

some of the minutia of the pulse rather than the global picture presented in

most texts present and past. And.....that there are texts present and past that

prescribe herbal remediation based on smaller increments of the pulse picture.

 

Will

 

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