Pulse (was Anthrax)

[Guest guest]

At 2:53 PM +0000 10/13/01, Bob Xu wrote:

>>As to the objective pulse system, we might have some differences in the

>>definition of " objective " .

 

--

 

I think the issue has to do with consensus, and that the idea of

objectivity is a bit of a red herring; ie, we should be in a position

such that certain pulse sensations are sufficiently well known by

well trained practitioners that reporting them is considered

reliable. For example, we can probably all agree that pulse rate is

measurable, and wouldn't doubt another practitioner who reported it.

Likewise probably with rhythm. That accounts for 5 of the 28

qualities. Beyond that we as a profession are in a fairly dire state

so far as pulse consensus is concerned; but this is not because the

sensations are subjective or hard to master. Our college training in

pulse diagnosis is pitiful, especially in clinic where it could

really be clarified and the consensus established. Until the basic

training is reliable our profession can't even talk to itself about

pulse, let alone convince practitioners of biomedicine that it is

useful.

 

Rory

[Guest guest]

I agree with Rory that the issue of pulse diagnosis and competency in

its training and practice is one of the biggest issues facing our

profession. There is not enough emphasis or time given to it in our

schools. I always cringe when I hear so many of my colleagues saying

the pulse is 'subjective'. Basically, this is saying that we do not

have reliable diagnostic methods, and have to rely completely on

biomedical diagnosis. Without competent pulse diagnosis as one of the

cornerstones of the practice of Chinese medicine, we cannot have an

independent health care profession.

 

 

 

 

 

On Saturday, October 13, 2001, at 06:04 PM, Rory Kerr wrote:

 

> I think the issue has to do with consensus, and that the idea of

> objectivity is a bit of a red herring; ie, we should be in a position

> such that certain pulse sensations are sufficiently well known by

> well trained practitioners that reporting them is considered

> reliable. For example, we can probably all agree that pulse rate is

> measurable, and wouldn't doubt another practitioner who reported it.

> Likewise probably with rhythm. That accounts for 5 of the 28

> qualities. Beyond that we as a profession are in a fairly dire state

> so far as pulse consensus is concerned; but this is not because the

> sensations are subjective or hard to master. Our college training in

> pulse diagnosis is pitiful, especially in clinic where it could

> really be clarified and the consensus established. Until the basic

> training is reliable our profession can't even talk to itself about

> pulse, let alone convince practitioners of biomedicine that it is

> useful.

>

> Rory

>

 

>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

>

>

>

[Guest guest]

, " " <zrosenbe@s...> wrote:

 

I always cringe when I hear so many of my colleagues saying

> the pulse is 'subjective'.

 

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?

 

[Guest guest]

My opinion is that this reflects a deep

seated cultural bias that can be summed

up in the word hedonism. There is a prevailing

attitude, particularly among Californians

(and I am a native Californian) that people

should spend their time doing things that

are easy, quick, and pleasurable.

 

Things that are difficult, time consuming

and bitter are to be shunned and avoided

according to this cultural bias.

 

The adaptation of Chinese medicine in

California reflects the gap that exists

between the culture of the subject's

origins and this prevailing cultural

set. We are now getting a poignant

and painful lesson in how the clash

of cultures can lead to pain and

suffering and death.

 

The culture of Chinese medicine includes

this awareness that in order to thrive

people need to engage in activities

that are difficult, strenuous, time

consuming, and bitter.

 

This means that teachers have to tell

their students over and over that they

do not yet understand in order to guide

them towards correct understanding.

 

No doubt there are those who will read

that last sentence and say something

like, " Well who are you to say what is

correct? "

 

QED.

 

Ken

 

, @i... wrote:

> , " " <zrosenbe@s...>

wrote:

>

> I always cringe when I hear so many of my colleagues saying

> > the pulse is 'subjective'.

>

> 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?

>

 

[Guest guest]

Rory,

 

> Our college training in

> pulse diagnosis is pitiful, especially in clinic where it could

> really be clarified and the consensus established. Until the basic

> training is reliable our profession can't even talk to itself about

> pulse, let alone convince practitioners of biomedicine that it is

> useful.

 

A valid point and well put. I think the

operant phrase here is " can't even talk to

itself. " The whole of Chinese medicine

is a communications process, and the

current adaptation of the subject has

tended to neglect and/or debase its

language. This results in communication

becoming, as you point out, impossible.

 

I've prepared a lengthy essay on this

point in the forthcoming issue of

CAOM which will be out in December.

And for those who want to pursue

the discussion, we welcome input

from all sources.

 

Ken

[Guest guest]

Rory:

 

I think the problem can be simplified in order to solve it. Consider

first that we need only agree that the Normal (Huan mai) pulse be

considered as an objective standard. It is self-referential to each

patient (its rhythm relates to breathing, the physical symmetry of

the horizontal and vertical dimensions of yin and yang, and the

consistency in its density). It reflects most, if not all, theories.

I wrote about it as such in my article on " The Normal Pulse. "

 

And it is simple enough to teach. The other basic pulses can be

approached using fuzzy logic.

 

Jim Ramholz

 

 

 

 

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

> At 2:53 PM +0000 10/13/01, Bob Xu wrote:

> >>As to the objective pulse system, we might have some differences

in the definition of " objective " .

>

> --

>

> I think the issue has to do with consensus, and that the idea of

> objectivity is a bit of a red herring; ie, we should be in a

position

> such that certain pulse sensations are sufficiently well known by

> well trained practitioners that reporting them is considered

> reliable. For example, we can probably all agree that pulse rate is

> measurable, and wouldn't doubt another practitioner who reported

it.

> Likewise probably with rhythm. That accounts for 5 of the 28

> qualities. Beyond that we as a profession are in a fairly dire

state

> so far as pulse consensus is concerned; but this is not because the

> sensations are subjective or hard to master. Our college training

in

> pulse diagnosis is pitiful, especially in clinic where it could

> really be clarified and the consensus established. Until the basic

> training is reliable our profession can't even talk to itself about

> pulse, let alone convince practitioners of biomedicine that it is

> useful.

>

> Rory

[Guest guest]

Students should be beaten regularly.

 

Jim Ramholz

 

 

, @i... wrote:

> , " " <zrosenbe@s...>

wrote:

>

> I always cringe when I hear so many of my colleagues saying

> > the pulse is 'subjective'.

>

> 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?

>

 

[Guest guest]

Pulse is a subject that I struggle with. I wonder whether it is and art form

that takes years to master ? Or is it a technical skill that improves with

practice. Or perhaps a combination of both ?

 

While in school, I conducted an experiment with a few of my teachers by having

each of them take my pulse. I did this with each teacher privately, thus they

could not be influenced by each other. My findings where that most of the

teachers had a different interpretation. It

wasn't that they used a different term to describe the same pulse. How was I

as a student develop a standard interpretation of the pulse in light of the

various and sometimes contradictory readings from my teachers who BTW, where all

Chinese with years of experience in China?

 

I have also made an effort to memorize all 28 pulses according to Bob Flaws’

teachings. This has helped to some degree, but it has not helped with most of

the pulse’s descriptions. It’s almost like memorizing what a note in the piano

would sound like by knowing the note’s

frequency without ever hearing the sound.

 

I have also attempted a Japanese approach to pulse reading by reading both hands

at the same time and comparing their differences. Sometimes this has helped. At

others not.

 

I am still looking for that patient with the “normal pulse”. Most patients I

see come because of some form of imbalance and thus an “abnormal pulse”. Where

can I get a copy of your article?

 

I wonder if my patient’s arm’s were amputated, would that mean a true tcm

diagnosis could not be given? And how many of us could treat the Emperor’s wife

by just taking her pulse?

 

fernando

 

 

 

James Ramholz wrote:

 

> Rory:

>

> I think the problem can be simplified in order to solve it. Consider

> first that we need only agree that the Normal (Huan mai) pulse be

> considered as an objective standard. It is self-referential to each

> patient (its rhythm relates to breathing, the physical symmetry of

> the horizontal and vertical dimensions of yin and yang, and the

> consistency in its density). It reflects most, if not all, theories.

> I wrote about it as such in my article on " The Normal Pulse. "

>

> And it is simple enough to teach. The other basic pulses can be

> approached using fuzzy logic.

>

> Jim Ramholz

>

>

[Guest guest]

At 3:23 AM +0000 10/14/01, wrote:

>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?

--

 

At least in the teaching I do reaching consensus about the

description of felt pulses consumes a majority of the time. Shen's

system includes the 28 pulses as its foundation, so it is not at all

at odds with standard TCM; it simply goes beyond it as well. In my

limited experience in clinic with him, John Shen always described the

pulses he was feeling in terms of the standard pulse qualities, and

in fact kept it pretty simple. He used the many other sensations and

positions to gain special insights or add refinement to the

diagnosis, but did not ignore the overall context reflected by the

main qualities.

 

Rory

[Guest guest]

At 8:13 AM -0400 10/14/01, Fernando Bernall wrote:

>While in school, I conducted an experiment with a few of my teachers

>by having each of them take my pulse. I did this with each teacher

>privately, thus they could not be influenced by each other. My

>findings where that most of the teachers had a different

>interpretation. It

>wasn't that they used a different term to describe the same pulse.

>How was I as a student develop a standard interpretation of the

>pulse in light of the various and sometimes contradictory readings

>from my teachers who BTW, where all Chinese with years of experience

>in China?

--

Well, it is encouraging that they agreed as to the qualities

identified. That means there is consensus as to sensation amongst

your teachers.

 

So far as interpretation goes, your experiment points out the fallacy

of making a diagnosis only from the pulse. Chinese diagnosis requires

the four methods. Pulse qualities do not usually have only one

interpretation, and have different interpretations depending on

disease, body type, season, information from other diagnostic

methods, etc.

 

Rory

[Guest guest]

Hi,fernando,

 

Pulse is a subject that I struggle with. I wonder

whether it is and art form that takes years to master

? Or is it a technical skill that improves with

practice. Or perhaps a combination of both ?<

 

Both of them.

 

>While in school, I conducted an experiment with a few

of my teachers by having each of them take my pulse. I

did this with each teacher privately, thus they could

not be influenced by each other. My findings where

that most of the teachers had a different

interpretation. It

wasn't that they used a different term to describe

the same pulse. How was I as a student develop a

standard interpretation of the pulse in light of the

various and sometimes contradictory readings from my

teachers who BTW, where all Chinese with years of

experience in China?

 

I have also made an effort to memorize all 28 pulses

according to Bob Flaws?teachings. This has helped to

some degree, but it has not helped with most of the

pulse’s descriptions. It’s almost like memorizing

what a note in the piano would sound like by knowing

the note frequency without ever hearing the sound.<

 

You should started with six pulse:

Fu2-Chen2 Xu-shi2 Hua2-Se4 this is mentioned

from ancient TCM doctor.after that,the 28 pulse.

 

>I have also attempted a Japanese approach to pulse

reading by reading both hands at the same time and

comparing their differences. Sometimes this has

helped. At others not.<

It always work,I know.

 

I am still looking for that patient with the “normal

pulse? Most patients I see come because of some form

of imbalance and thus an “abnormal pulse? Where can I

get a copy of your article?

 

>I wonder if my patient’s arm’s were amputated, would

that mean a true tcm diagnosis could not be given? <

you got other clues to do diagnosis ,such as

tounge,facial look and symptems.

 

>And how many of us could treat the Emperor wife by

just taking her pulse?

Every one,because she have to continute her life.Ha!

 

The pulse diagnosis is really help.

 

Jean

 

 

 

 

 

 

 

 

 

 

=====

 

 

--

< ºô ¸ô ¥Í ¬¡¡EºÉ ¦b ©_¼¯ > http://www.kimo.com.tw

[Guest guest]

Jeansu wrote:

 

> Hi,fernando,

>

> Pulse is a subject that I struggle with. I wonder

> whether it is and art form that takes years to master

> ? Or is it a technical skill that improves with

> practice. Or perhaps a combination of both ?<

>

> Both of them.

 

> Dear Jean, if pulse diagnosis is both an art and technical skill, shouldn't

then be room for the artist's subjective interpretation? And at what point do we

make a separation?

>

> You should started with six pulse:

> Fu2-Chen2 Xu-shi2 Hua2-Se4 this is mentioned

> from ancient TCM doctor.after that,the 28 pulse.

>

 

I agree, and do use these six pulses in my practice. My point refers more to the

more subtle pulses such as the " scallion " and for that matter the popular

" slippery " pulse. I have taken the pulse on patients while in their period, or

pregnant, or with signs of phlegm to learn this

pulse, but the idea of pearls going around on a dish just does not do it. I

could not find a similar pulse on these patients. I can't help but admire those

practitioners who can discern different pulse qualities at the various levels.

However, at times I wonder how subjective

their interpretation is.

 

>

> >I wonder if my patient’s arm’s were amputated, would

> that mean a true tcm diagnosis could not be given? <

 

>

> you got other clues to do diagnosis ,such as

> tounge,facial look and symptems.

 

Again, I agree, and I do use all possible clues to make my assessments. Thanks,

 

fernando

 

> -

> < ºô ¸ô ¥Í ¬¡¡EºÉ ¦b ©_¼¯ > http://www.kimo.com.tw

>

> Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics specializing in

Chinese Herbal Medicine, provides a variety of professional services, including

board approved online continuing education.

>

>

>

>

[Guest guest]

Jim,

 

>Consider

> first that we need only agree that the Normal (Huan mai) pulse be

> considered as an objective standard. It is self-referential to each

> patient (its rhythm relates to breathing, the physical symmetry of

> the horizontal and vertical dimensions of yin and yang, and the

> consistency in its density). It reflects most, if not all,

theories.

> I wrote about it as such in my article on " The Normal Pulse. "

>

What is the Chinese word " huan " here?

 

The typical term used to describe a " normal "

pulse in Chinese is " zheng4 chang2 mai4 " .

I'm not familiar with the term you're

using. Can you clarify it?

 

For those who can see the Chinese characters,

zheng4 chang2 mai4 is Õý³£Âö.

 

Ken

[Guest guest]

, @i... wrote:

>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.

 

 

 

 

The student misunderstood the intention of his instructor.

I believe he experienced this in Min's class and the point

of the exercise was to develop our sensitivity and our

awareness of what we were feeling. A patient was brought

into the room and every one took turns feeling the pulse.

After the patient left, Min asked us to describe the

sensation we felt on palpation without using the textbook

descriptions or standard pulse names. We did this repeatedly

in every class throughout the semester. What Min hoped to

cultivate through this exercise was a higher level of attention

during palpation. If we were going to have to use our own

words, analogies, metaphors, or whatever to peg the pulse

quality, then we would have to pay very close attention to

what we were feeling under our fingertips. BEYOND THAT, however,

Min taught a very strict nomenclature for pulses according to

the classics and their clinical interpretations. We had to learn

the names in pinyin and english and the specific, text-book-like

ways of identifying them. His essay exams required very clear

reguritation of what each classical pulse felt like and could

possibly indicate.

 

While you have no doubt the student " learned this in class, "

I have no doubt that he selectively learned it as he chose to -

without understanding or embracing the true objective of Min's

teaching style. Sometimes students get so busy taking notes,

they forget to contemplate the more subtle goals of

their teachers.

 

I hope this insight helps.

 

Laurie

[Guest guest]

, Fernando Bernall <fbernall@a...>

wrote:

>

>

> Jeansu wrote:

>

> > >

> > you got other clues to do diagnosis ,such as

> > tounge,facial look and symptems.

>

> Again, I agree, and I do use all possible clues to make my

assessments. Thanks,

>

> fernando

>

>

 

Another point I bring up with students is something I read in an

essay by Dan Bensky several years back in the NAJOM. He said IIRC

that a good way to help develop your skills in pulse dx is to take

into account the other s/sx of the patient when examining the pulse,

especially when the pattern seems clear from the other examinations.

So for example if you know that the other s/sx are consistent with LR

qi depression (or constraint, to use his preferred term), then the

pulse can help you to clarify in your own mind the " wiry " quality.

[Guest guest]

, " James Ramholz " <jramholz> wrote:

> Students should be beaten regularly.

>

> Jim Ramholz

>

 

I have to reiterate because so many of my students are in this group

that this student was only doing what he was taught. How is he to

decide whether me or the other professor is correct in this matter?

 

I think corporal punishment is illegal in CA, BTW. For those who

didn't catch the wink, Jim was joking.

 

[Guest guest]

, Fernando Bernall <fbernall@a...> wrote:

 

>

> While in school, I conducted an experiment with a few of my teachers by having

each of them take my pulse. I did this with each teacher privately, thus they

could not be influenced by each other. My findings where that most of the

teachers had a different interpretation. It

> wasn't that they used a different term to describe the same pulse. How was

I as a student develop a standard interpretation of the pulse in light of the

various and sometimes contradictory readings from my teachers who BTW, where all

Chinese with years of experience in China?

 

Many of us have had this experience which is because pulsetaking is

also poorly trained in China itself. Ironically, the best pulsetakers

I have met have been americans. But consensus reamins lacking and w/o

consensus we have nothing.

 

[Guest guest]

 

 

>

> Many of us have had this experience which is because pulsetaking is

> also poorly trained in China itself.

 

How is it done there Todd?

 

Ironically, the best pulsetakers

> I have met have been americans.

 

This might be a reflection on your own

experience in meeting people. Have you

been in China? Japan? Korea? Obviously

the bulk of non-Americans are not in

America.

 

But consensus reamins lacking and w/o

> consensus we have nothing.

 

And without standardization of terms

consensus will remain lacking.

 

Ken

[Guest guest]

, tgperez@e... wrote:

 

>

> While you have no doubt the student " learned this in class, "

> I have no doubt that he selectively learned it as he chose to -

> without understanding or embracing the true objective of Min's

> teaching style. Sometimes students get so busy taking notes,

> they forget to contemplate the more subtle goals of

> their teachers.

>

> I hope this insight helps.

>

> Laurie

 

Thanks, Laurie. I was giving the student the benefit of the doubt

because I also know Min to be very precise about these things. So

while he may have " learned " this, apparently, this was not what he was

" taught " . Actually, the exercise you describe sounds quite creative

and useful.

 

[Guest guest]

, yulong@m... wrote:

>

>

> >

> > Many of us have had this experience which is because pulsetaking is

> > also poorly trained in China itself.

>

> How is it done there Todd?

 

several regular travelers to clinics in china have told me that modern

training diminishes the importance of the pulse compared to questioning

and tongue observation. that many students in china are also not adept

at the pulse and that few skillful pulsetakers are still teaching.

Admittedly hearsay, but that which is reflected in my observations of

many chinese practitioners here in the states.

 

>

> Ironically, the best pulsetakers

> > I have met have been americans.

>

> This might be a reflection on your own

> experience in meeting people. Have you

> been in China? Japan? Korea? Obviously

> the bulk of non-Americans are not in

> America.

 

Our personal experiences are always a reflection of our limited

contacts. No doubt there are great pulsetakers in China and I have

met a few here. that was not my point. It was about the bulk of those

whom I have actually met. While I have not traveled in Asia, I have

worked with about 30 experienced chinese docs over the past 14 years.

Many of them actually dismissed the importance of the pulse which

further aroused my suspicions on this matter. One of my teachers who

bemoaned the state of pulsetaking in china did make an exception for

chengdu, which I know is the college you frequent on your travels. I

also find most americans, including myself, to have mediocre

pulsetaking skills as a reflection of my poor training in this area.

However, a few americans I know have made this a vital pursuit and

truly excel in this area over any of the chinese I have met.

Admittedly, I have observed this " skill " exclusively amongst those who

are practicing pulse balancing methods where point choices result in

pulse changes that are observable in the course of one treatment. I

just remembered I also had a Japanese teacher who was very skillful

along the same lines, using a method comparing carotid to wrist pulses.

He was also very effective in training students to duplicate his

methods with high consensus. Not being very acupuncture oriented, I

had forgotten about this man. Perhaps my experience is also skewed by

hanging mainly with herbalists where we cannot observe pulse changes in

the treatment room because they happen when the herbs are taken at home

and cannot be assessed until the following week.

 

[Guest guest]

 

 

What prompted my response was that your

remarks seemed to forward a fact that

as I suspected is not actually a fact

but an aggregate of impressions. Like

you and, as you point out everybody,

my own impressions are simply that...

my impressions.

 

But I think that this discussion of

pulses emphasizes or at least ought to

emphasize the importance of the subtleties

of communication. Taking pulses is a subtle

art/skill. Communicating about taking

pulses is also a subtle art/skill.

 

One of the big differences I've noticed

between the way that education is conducted

in China and in this country is that typically

it is the older doctors with the years of

experience that you point out as a prerequisite

to understanding who occupy the positions as

teachers there, while many of those teaching

the subject here are themselves relatively

new at it.

 

A great deal can be gained from an experienced

teacher in a relatively short span of time. I've

experienced this in taiji classes as recently

as last Thursday night. One or two words from

an experienced teacher can change the way I

look at something I've been doing for decades.

 

Of course there must be a reliable line of

communication between student and teacher

in order for such transmission to take place.

I have to wonder how much your informants

actually understood of what they witnessed

in Chinese clinics. I know that I spent

years in such environments understanding

relatively little of what I was being told

and shown.

 

If we look at the issue from the perspective

of results, we can see that Chinese pulse takers

as a group have established a public health

delivery operation that services a substantial

percentage of the population using the skills

that they have received from their teachers

and developed in the course of their own

clinical practice. Chengdu may indeed be

exceptional as an environment for TCM

in China, but I have been in clinics in

other Chinese cities where I can tell you

the art of pulse diagnosis is alive and well.

 

The fact that we even have a subject to

talk about is a result of the transmission

of the knowledge and skills by the Chinese

as well as Japanese, Koreans and other

national groups over many centuries.

 

So I continue to think it is ill advised

to dismiss the levels of comptence that

exist in those places in favor of the

supposed expertise of folks who by

any objective measure are relative

newcomers.

 

Ken

 

, @i... wrote:

> , yulong@m... wrote:

> >

> >

> > >

> > > Many of us have had this experience which is because

pulsetaking is

> > > also poorly trained in China itself.

> >

> > How is it done there Todd?

>

> several regular travelers to clinics in china have told me that

modern

> training diminishes the importance of the pulse compared to

questioning

> and tongue observation. that many students in china are also not

adept

> at the pulse and that few skillful pulsetakers are still teaching.

> Admittedly hearsay, but that which is reflected in my observations

of

> many chinese practitioners here in the states.

>

> >

> > Ironically, the best pulsetakers

> > > I have met have been americans.

> >

> > This might be a reflection on your own

> > experience in meeting people. Have you

> > been in China? Japan? Korea? Obviously

> > the bulk of non-Americans are not in

> > America.

>

> Our personal experiences are always a reflection of our limited

> contacts. No doubt there are great pulsetakers in China and I

have

> met a few here. that was not my point. It was about the bulk of

those

> whom I have actually met. While I have not traveled in Asia, I

have

> worked with about 30 experienced chinese docs over the past 14

years.

> Many of them actually dismissed the importance of the pulse which

> further aroused my suspicions on this matter. One of my teachers

who

> bemoaned the state of pulsetaking in china did make an exception

for

> chengdu, which I know is the college you frequent on your travels.

I

> also find most americans, including myself, to have mediocre

> pulsetaking skills as a reflection of my poor training in this

area.

> However, a few americans I know have made this a vital pursuit and

> truly excel in this area over any of the chinese I have met.

> Admittedly, I have observed this " skill " exclusively amongst those

who

> are practicing pulse balancing methods where point choices result

in

> pulse changes that are observable in the course of one treatment.

I

> just remembered I also had a Japanese teacher who was very skillful

> along the same lines, using a method comparing carotid to wrist

pulses.

> He was also very effective in training students to duplicate his

> methods with high consensus. Not being very acupuncture oriented,

I

> had forgotten about this man. Perhaps my experience is also skewed

by

> hanging mainly with herbalists where we cannot observe pulse

changes in

> the treatment room because they happen when the herbs are taken at

home

> and cannot be assessed until the following week.

>

 

[Guest guest]

, yulong@m... wrote:

Chengdu may indeed be

> exceptional as an environment for TCM

> in China, but I have been in clinics in

> other Chinese cities where I can tell you

> the art of pulse diagnosis is alive and well.

 

As we are talking about consensus and standards, not merely practices,

several questions are begged by your statements.

 

1. Are you saying that if you put 20 experienced old chinese doctors

in a room in China, they would achieve a consensus on the pulses of a

given grouop of patients?

 

2. If this is the case, then why is it so poorly reflected by the

Chinese physicians who happen to teach in the US?

 

the nice thing about having a group like this one to bat around

questions is that suppositions are not merely my own. I'd wager that

just about everyone in this group has had the experience of his Chinese

teachers typically NOT achieving consensus on the pulse. So we are not

just talking aboyut the 30 teachers I know, but perhaps hundreds of

practitioners across the country, all of whom were trained in China.

The conclusion that jumps to my mind is that this large group of people

had some deficiency in their training, as well. I find it harder to

accept that by chance all the chinese in America were poorly trained in

pulse, but that this is no reflection on the actual homeland situation.

these same teachers achieve a remarkable consensus on diagnosis, tongue

observation, etc. It is the pulse alone where there seems to be little

if any consensus. I'd welcome an alternate hypothesis of why this is

so or input from others who have had different expeiences than myself.

But when this subject has come up in the past (and it has at least

several times), the refrain is always the same:

 

1. people with chinese teachers have little experience observing

consensus about pulsetaking amongst their professors

 

2. reliability has been seen in some japanese traditions where there

is a tremendous emphasis on training to achieve this goal

 

[Guest guest]

 

 

>

> As we are talking about consensus and standards, not merely

practices,

> several questions are begged by your statements.

>

> 1. Are you saying that if you put 20 experienced old chinese

doctors

> in a room in China, they would achieve a consensus on the pulses of

a

> given grouop of patients?

 

I don't know of any studies that have demonstrated

this or even addressed the issue. I believe that

the broad base of familiarity with concepts and

the similarly broad background of clinical experience

among veteran Chinese physicians practicing traditional

medicine there provides what is essentially an

alternative to " consensus " , i.e. a reliability

that both doctors and patients experience with

respect to a wide range of issues, including

the accuracy of pulse diagnosis.

 

As has been pointed out, diagnosis is a composite

activity, the pulse being one component which

fits into the whole process in an interactive

way that, practically speaking, cannot be readily

abstracted from the other methods.

 

I've been taught that one of the curious features

of traditional Chinese medicine is that if you

take 10 (or even 20) competent doctors and let

them all examine one patient, you will find

that there may be little in the way of agreement

among the doctors as to what is wrong or how

to go about dealing with it. Yet many if not

all of these differing approaches may prove

successful in alleviating the condition.

 

 

>

> 2. If this is the case, then why is it so poorly reflected by the

> Chinese physicians who happen to teach in the US?

 

There are a number of factors that come to

bear on the character and quality of doctors

from mainland China who have arrived in

the States over the past twenty years or

so. Some have been trained not as traditional

doctors but as Western medical doctors and

have, because of the relative difficulty

of gaining licenses to practice as MDs

here in the States, opted for the comparatively

easy chore of being licensed as acupuncturists.

 

I have no figures on this, but I have encountered

several individuals who fit this description.

They are, of course, Chinese doctors. But they

do not reflect even the training standards

of the subject when they were in China.

 

Another factor is the language issue that

we have talked about until we are all blue

in the face. But with the general lack of

standards prevailing it is not reasonable

to expect that individuals often with poor command

of the English language and questionable

command of the subject itself demonstrate

a high level of inter-rater reliability.

 

The Chinese have an old saying, " Sing the

local tune, " which guides them to blend

into the customs and practices of new

places in which they find themselves.

Chinese, especially traditional Chinese,

are predisposed thereby not to assert their

own standards when operating in foreign

environments. When seeking to blend in

with a scene such as the one we have

built here, many Chinese experience a

good deal of difficulty and frustration.

 

 

 

Still another factor is that the old veteran

doctors, at least the ones that I've met in

China, shun the idea of emigrating to the

West, preferring to spend their waning

days working and teaching in their native

land.

 

 

> the nice thing about having a group like this one to bat around

> questions is that suppositions are not merely my own.

 

I'm not even really challenging your suppositions.

I responded originally to your remark that pulse

is poorly taught in China because you didn't

identify it as a supposition, either yours or

some poorly defined group's. You stated it as

if it were a known fact. I don't think it is

a fact.

 

I'd wager that

> just about everyone in this group has had the experience of his

Chinese

> teachers typically NOT achieving consensus on the pulse. So we are

not

> just talking aboyut the 30 teachers I know, but perhaps hundreds of

> practitioners across the country, all of whom were trained in China.

 

Again, the operant phrase here is " trained in China. "

I would love to see a properly conducted and documented

study that reveals the training levels

that Chinese doctors and teachers bring with them

to this country.

 

 

> The conclusion that jumps to my mind is that this large group of

people

> had some deficiency in their training, as well.

 

It's an understandable conclusion to have jumping

into mind. I'm just not content with the subsequent

conclusion that the subject of pulse diagnosis is

poorly taught in China. It's a generalization that

is so broad that it lacks both accuracy and usefulness.

 

It also leads to a further devaluation of the Chinese

experience with respect to pedagogy in Chinese

medicine, and as I've said, I think this is a

mistake.

 

I find it harder to

> accept that by chance all the chinese in America were poorly

trained in

> pulse, but that this is no reflection on the actual homeland

situation.

> these same teachers achieve a remarkable consensus on diagnosis,

tongue

> observation, etc. It is the pulse alone where there seems to be

little

> if any consensus.

 

I think that by its nature, the taking of pulses

is a far more subtle and individual activity

than examination of tongues or the coming

to conclusions as to what an assembled body

of diagnostic data reveals. Therefore it's

not altogether surprising that this point

stands out among others.

 

The comparison to the Japanese experience

also reveals as much if not more about the

relative strengths and weaknesses of the

two cultures as it does about pulse taking

per se. The Chinese are a fiercly indivdualistic

people, despite American stereotyping to

the contrary. Another old Chinese saying

holds that " One Chinese person is a dragon

but three Chinese people are a worm. "

 

As I said, I'm not arguing against your

suppositions rather suggesting that we

take some care to identify what it is

we are supposing. I'm also not arguing

against consensus, inter-rater reliability

or the Japanese approach to pulse training.

 

I think there are enough complicating factors

in the environment to warrant such caution

and despite the fact that conclusions tend

to jump into mind, I think we all need to

be a little less ready to jump ourselves.

 

Ken

[Guest guest]

Hi,fernando,

 

Thank you for the question.

 

> Dear Jean, if pulse diagnosis is both an art and

technical skill, shouldn't then be room for the

artist's subjective interpretation? And at what point

do we make a separation?

 

Well,I don't think the auditor(listener) or reader

,even artist ,can tinterpretation Mozat or Picaso and

many great artists very clearly,too.

 

TCM is a great ART.I don't know why western people

always eager to figure out a standard for TCM,which

we never think about because TCM combind with all

Eastern culture and it is impossible to make clear

cut like western Medicine.Because we are Marco.

 

Could you predict the weather 100% correct?I guess

" no " ,because it change all the time,As well as TCM

theory for the patient.every person is changing every

sing time unit,when you eat food,it get changed.When

you sweat,The situation is changed.

 

We see patient is changing object.Western Medicine

see patient is standard,just follow the treatment

procedure,step by step ,the desease will be cure,the

bacteria and virus will get killed ,just follow the

procedures.

 

We do have same procedures,too.But it is in different

theory and diffient philosophy and thinking process

then WM.TCM theory are totally different then WM

,so,it had better not to set stardand for TCM ,

Standard TCM everything will killing TCM because TCM

is focus on " changing " .

 

Excellent TCM doctor doesn't quite use standard TCM

herbal formula,they create their own herbal formula

and this is according to the patient's " changing "

 

Back to the issue.TCM doctor is an artist.But,Artist

has different degree level.Like Mozart and regular

musician,Picaso and regular artist.

 

Excellent TCM Artist need time to be Mozart and

Picaso,it might need 30-50 years ,also ,plus your

excellent talent,too.

 

>I agree, and do use these six pulses in my practice.

My point refers more to the more subtle pulses such as

the " scallion " and for that matter the popular

" slippery " pulse. I have taken the pulse on patients

while in their period, or pregnant, or with signs of

phlegm to learn this pulse, but the idea of pearls

going around on a dish just does not do it. I could

not find a similar pulse on these patients.

 

Yes,because TCM See patient as " changing objects " ,even

the patients got same WM diagnosis,their pulse maybe

quite different because patient lives in different

daily way,eat diffient daily food,different sleep

type,different water drink type.TCM has no standard

because no one can be all the same,even twins.

 

>I can't help but admire those practitioners who can

discern different pulse qualities at the various

levels. However, at times I wonder how subjective

their interpretation is.

 

Pule diagnosis is water flu in a soft tube,you have

to feel the water and water speed through the soft

tube.Feeling it by your heart(open your heart

eyes,Haa!),the water speed and water ingredent will

more and more clear day by day.Memory pulse theory and

fell it when you meet different patient.Some day you

will be one of them.

 

Jean

 

=====

 

 

--

< ºô ¸ô ¥Í ¬¡¡EºÉ ¦b ©_¼¯ > http://www.kimo.com.tw

[Guest guest]

Ken:

 

Huan mai is from the Wiseman dictionary, of course. In it, he says of

huan mai, " Construed as a normal pulse, it is even and moderate, and

is a sign of the presence of stomach qi . . . " ---although I wouldn't

agree with his second half of the definition because once it

is " without strength " and mostly " seen in dampness patterns and in

spleen-stomach vacuity " it is no longer moderate. You can't have it

both normal and pathological---no wonder why people are confused by

CM.

 

I've taken the liberty of uploading my article on the Normal Pulse

which has a table of comparison between various translations of

pinyin pulse terms, including those from my own Korean system of

pulse diagnosis.

 

Jim Ramholz

 

 

 

 

 

 

 

What is the Chinese word " huan " here?

 

The typical term used to describe a " normal "

pulse in Chinese is " zheng4 chang2 mai4 " .

I'm not familiar with the term you're

using. Can you clarify it?

 

For those who can see the Chinese characters,

zheng4 chang2 mai4 is Õý³£Âö.

 

Ken

 

 

 

 

James Ramholz, O.M.D.

1st Avenue Chiropractic Center

100 Monroe

Denver, CO 80206

(303) 522-3348