pulse

[Guest guest]

------ " From your description, it sounds like a type of knotting (jie)

movement I've been describing in the PulseDiagnosis forum---it's

slightly different the Li Shi-zhen description.

 

If the irregular movement rises to the finger and seems to vibrate or

be choppy ( " tiny pellets " ) at the top without a descending quality,

it is indicative of tumor, blocked lymph nodes, phlegm blockage, or

deep brusing. It can also be the blockage from the scarring of the

lumpectomy. If it happens at each pulse movement, then it would be

cancer. " ------

 

The position the pulse was found in was only the right distal

position. It did not have a descending quality. I don't know if I

mentioned it or not in my last post, but it was her right breast that

the cancer was found in, and they removed a couple of lymph nodes.

So, your explanation, Jim, makes a lot of sense. And it did not

happen at each pulse movement; it only happened twice. I saw her

again yesterday, and I did not notice such a dramatic pulse. The

pulse in general was slippery, except for the right cun which felt a

little less fluid.

 

As far as her symptoms are concerned, she is on the warm side, and

has been getting flushed the past few weeks, with sweat on her

forehead. In general, she drank a lot of alcohol and smoked a lot of

marijuana (before her diagnosis). She has a very strong family

history of breast cancer; her mom was diagnosed at age 41 and died at

age 47. She also has many cousins on her mom's side who had it. She

always appears slightly nervous, and has some nervous twitches. Her

periods are irregular and very long - they last 10 days with heavy

bleeding, occasionally with clotting. She had finished her period a

few days before I saw her, and got another period the day following

her treatment. She is also very emotional; she can have outbursts

and be argumentative; and her voice usually seems as if she is

crying. She is on the heavy side, and has some digestive troubles.

 

Thank you everybody for your input.

 

Ross

[Guest guest]

So nobody wants to take me up on doing a study on pulse diagnosis? Kind of makes me wander

Alon

[Guest guest]

How soon can you send me an airline ticket?

 

Jim Ramholz

 

 

, <alonmarcus@w...> wrote:

> So nobody wants to take me up on doing a study on pulse diagnosis?

Kind of makes me wander

> Alon

[Guest guest]

How soon can you send me an airline ticket

>>>>Unless I get funding from Kaiser, which I do not I will, this will have to be on a volunteer bases. But don't you think we need to do such a study.

Alon

 

[Guest guest]

Wang Shuhe describes qualities beyond the basic 28. For instance, he goes into describing various qualities within the arrival of the wave. He also adds complementary positions and definitions for the eight extraordinary vessel pulses.

 

Some modern practitioners get into the rate of arrival. Shen/Hammer discuss pounding with force and without force - both an elevated rate on arrival. Yang Tiende describes this as urgent. Rate of arrival is the only way to explain classical passages describing the pulse as faster in one position than in another. It is also useful in the intern clinic for those interns who report a rapid pulse yet upon comparison with the clock find a normal rate.

 

Will

[Guest guest]

, @i... wrote:

>

> I recently had a student tell me his patient's pulse

felt like he

was

> pushing through cotton. I asked him if he could

identify his

> subjective description with one of the 28 pulses.

He said he

couldn't

> and I told him that his description, accurate as it

may be, wasn't

very

> useful for me. I told him that in order for a pulse

quality to

have

> diagnostic significance, it had to be named with one

of the

technical

> terms of TCM palpation. That way I could correlate

it with excess,

> deficiency, organs, etc. He was visibly upset with

me. I asked if

he

> interpreted the pulse he was describing to reflect a

vacuity. He

said

> yes. A little while later he came back and told me

he had been

taught

> in his diagnosis class to describe the pulse in his

own words and

NOT

> concern himself with the technical terms like

vacuous, weak,

thready,

> soggy, etc. He said he understood my point, but he

could not

reconcile

> the two positions. I have no doubt he learned this

in class. He

is a

> very astute, conscientious student, spending all his

free time in

> clinic studying and asking intelligent questions. I

think this is

a

> separate issue from variations in pulse taking

systems, such as

John

> Shens or donghan. I assume one can only come to

consensus in those

> systems by also using a shared terminology and not

merely

describing

> the pulse in one's own words. Does anyone have an

opinion on

this?

>

 

 

I understand what you're saying and I think you're

right in terms of the necessity for consensus.

Toyohari association uses the description of floating

cotton for a pulse quality (I've noted this

description for the classical soggy pulse as well),

but specific techniques have been developed by

consensus to tx this particular pulse. These

designations and techniques are not very meaningful

outside of Toyohari however.

 

I can't help but wonder, though, whether the

designations of pulse quality from the Han through

Ming periods are the limit of possible pulse qualities

that can be described clinically. Mai Jing after all

described 24 and a milennium later Bin Hu Mai Xue

described 28. I wonder since technology has expanded

exponentially in the last century, and patients are

ingesting so many varied pharmaceuticals (just as one

example) if the range of describable pulse qualities

would not be expanded as well.

 

Of course we need to build consensus, but don't

automatically stomp your student's creativity into the

ground. I'd try to work through the pulse description

to come to one or more qualities that may be suitable.

 

 

I teach palpatory skills quite often, and I have to

say it is highly unsatisfactory to communicate tactile

sensations verbally. Without Li Shi-zhen to put your

fingers on the vessel and show you what he means by a

certain quality, how can you really be certain that

your bodily sensation is the same as his was in the

Ming? I teach dx class highly imperfectly, and I

admit to my students that my pulse dx skills are

largely a product of my training with blind teachers

and may not reflect the consensus of the TCM community

as a whole.

 

Lastly, even my first teacher from China, an herbalist

of considerable experience, emphasized to me that the

most important pulse data was the six basic qualities

(floating/deep, fast/slow, replete/vacuous) and that

everything else was basically a variation on these.

Lo and behold, all of the teachers I've ever studied

under who have had more than 20 or 30 years of

experience have told me the same thing. So this is

what I tell my students.

 

 

 

 

=====

Robert Hayden, L.Ac.

http://jabinet.net

 

 

 

Make a great connection at Personals.

http://personals.

[Guest guest]

At 6:05 AM -0700 10/14/01, robert hayden wrote:

>I can't help but wonder, though, whether the

>designations of pulse quality from the Han through

>Ming periods are the limit of possible pulse qualities

>that can be described clinically. Mai Jing after all

>described 24 and a milennium later Bin Hu Mai Xue

>described 28.

--

There are many other sensations on the pulse - and it is possible to

ascribe meaning to some of them. Whether they can gain widespread

acceptance as meaningful is another matter.

 

>

>Lastly, even my first teacher from China, an herbalist

>of considerable experience, emphasized to me that the

>most important pulse data was the six basic qualities

>(floating/deep, fast/slow, replete/vacuous) and that

>everything else was basically a variation on these.

>Lo and behold, all of the teachers I've ever studied

>under who have had more than 20 or 30 years of

>experience have told me the same thing. So this is

>what I tell my students.

--

John Shen started out one lecture saying that there were only four

qualities. Needless to say that was not what his audience wanted to

hear.

 

But what about slippery, choppy, intermittent, bowstring, tight,

short, long, moving?

 

Rory

[Guest guest]

There is an interesting essay in the

book called Cheng-Tzu's Thirteen Treatises

on T'ai Chi Ch'uan by Cheng Man Ch'ing,

translated by Benjamin Lo and Martin Inn.

It's applicable to the subject of the

pulse and the process whereby we learn

to feel and comprehend its various

meanings.

 

In this essay Cheng, who was both a

master of Tai Chi and an accomplished

doctor of traditional medicine, describes

three levels of Tai Chi Ch'uan and three

degress of each level. Quoting from

page 75 of the hardback edition of

1985 (North Atlantic Books):

 

" There are three different levels of T'ai

Chi Ch'uan - Heaven, Earth, and Human.

The Human Level relaxes your sinews and

vitalizes your blood; Earth Level " opens

the gates " so that the ch'i can reach the

joints; and Heaven Level exercises the sensory

function. "

 

At the end of this treatise, the eleventh

of the thirteen, Cheng offers the following

admonition:

 

" Students give up the immediate to see the

exotic; they don't understand the sheer marvelous

function of the ch'i accumulating in the

tan t'ien. The ch'i is just like wind,

water, and clouds. They each can store up

power as the universe itself stores up

the primal ch'i. Mencius talked about

cultivating the " Great Ch'i, " which is

omnipotent and indestructible and fill us

the entire universe. It is easy to observe

and comprehend the power of wind and water

but not that of the clouds and ch'i. "

 

Clearly, when we feel a patient's pulses

we are using our sensory capacities to

comprehend the force of the patient's

ch'i (qi4). In other words, we are

connecting our own qi4 with that of

the patient's. This suggests that our

understanding of pulse cannot exceed

the degree to which we have cultivated

our own qi4. Therefore this little essay

by a great tai4 ji2 master is directly

applicable to our quest to develop our

understanding and skill at pulse

diagnosis.

 

Ken

[Guest guest]

>At 10:50 AM -0400 10/14/01, WMorris116 wrote:

>the intern clinic

--

Will, I know that you have made valiant efforts to upgrade the status

of pulse education it Emperor's. How has it worked out, particularly

in clinic?

 

Rory

[Guest guest]

, Rory Kerr <rorykerr@w...> wrote:

> > --

> There are many other sensations on the pulse - and it is possible

to

> ascribe meaning to some of them. Whether they can gain widespread

> acceptance as meaningful is another matter.

>

 

Did Wang Shuhe attempt to arrive at a consensus with other

practitioners of his age or did he just write down what he found

meaningful clinically? One wonders. How widely accepted were these

significations at the time he was practicing?

 

> >

> --

> John Shen started out one lecture saying that there were only four

> qualities. Needless to say that was not what his audience wanted to

> hear.

>

> But what about slippery, choppy, intermittent, bowstring, tight,

> short, long, moving?

>

 

 

In Meridian Therapy, slippery and choppy are frequently added to the

list of basic pulse qualities as well. Certainly, in Fukushima

Kodo's book as well as Shudo Denmei's, the 28 pulses are deemed to be

important -- but not until there is a firm grasp of the basic pulse

qualities. They're talking years/decades as opposed to

quarters/semesters. I'm happy if my students can identify something

other than a wiry pulse by the time they graduate.

 

Maybe comparing Toyohari to TCM is in some ways apples/oranges, for

one is focused exclusively on acumoxa and the other on a broad range

of modalities, primarily natural drug therapy. But when I'm teaching

pulse dx, the most comprehensive and consistent methodology I've

studied is Toyohari -- the inter-rater reliability is high, and the

pedagogy is well planned and effective, particularly in teaching

palpatory skills, especially pulse taking. The blind teachers can

tell things like what angle the student is holding the needle by

feeling the pulse of the patient being treated.

 

Of course I've never studied with any of Dr Hammer's or Dr Sung

Baek's students, which again as Todd pointed out each have their own

methods of pedagogy and consensus, and likely have a similar

reliability profile.

[Guest guest]

I wonder since technology has expanded

> exponentially in the last century, and patients are

> ingesting so many varied pharmaceuticals (just as one

> example) if the range of describable pulse qualities

> would not be expanded as well.

>

> Of course we need to build consensus, but don't

> automatically stomp your student's creativity into the

> ground. I'd try to work through the pulse description

> to come to one or more qualities that may be suitable.

>

 

There may certainly be more to say about the pulse than has been

written, but I would offer that that is a task for a master at the end

of his career, not a student at the beginning. So while it may be

worthwhile for the student to pursue this activity,it does not help me,

him or the patient in the clinical process as it currently exists, i.e.

where I correlate a technical pulse term with other s/s to arrive at a

pattern dx.

 

[Guest guest]

In a message dated 10/14/01 11:10:29 AM Pacific Daylight Time, rorykerr writes:

 

 

Will, I know that you have made valiant efforts to upgrade the status of pulse education it Emperor's. How has it worked out, particularly in clinic?

 

 

Rory...it is more difficult than you can imagine. The convenience of status quo is prevalent. It is not possible to generate core curriculum that someone with a bachelor's degree from China could not teach.

While I have not established academic structure for deeper programs, my seminars flourish. The good thing is there are three clinical faculty who know the material so there is a support system in the clinic for those interns who have such interest.

 

Will

[Guest guest]

Hi,Rory ,

 

>But what about slippery, choppy, intermittent,

bowstring, tight, short, long, moving?

 

Feeling it by your self.

 

Jean

 

 

 

=====

 

 

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