Pulse (was Anthrax)

[Guest guest]

, Fernando Bernall <fbernall@a...>

wrote: 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?

 

 

Fernando:

 

I have seen only a few people with a normal pulse come in the door

because they're healthy---they were not ill, just curious. When

treating someone, you want to see their pulses change from their

abnormal, imbalanced condition to as close to the normal pulse as

possible. According to the Mai Jing, if the pulse looks normal, even

if the patient is diseased, " there is life. " Which is to also

say, 'their condition will improve.'

 

I have uploaded a copy of my article to the Files section of the

forum.

 

Jim Ramholz

[Guest guest]

Jim,

 

> Huan mai is from the Wiseman dictionary, of course.

 

But is not the term you find if you look up " normal pulse. "

 

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.

 

As I read this quote from the Practical Dictionary

it means, if you construe a moderate pulse as normal,

which I would take to imply an instance where no

other pathological changes were present, then it

simply reflects the presence of stomach qi4. When,

on the other hand, a moderate pulse is felt in

the presence of dampness patterns or cases of

spleen-stomach vacuity, it is indeed a diagnostic

indication of those conditions.

 

> You can't have it

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

> CM.

 

Indeed. Except, as I read the current confusion

it is one that you have introduced by redefining

one term to mean another. The Chinese word huan3

means " 1. slow, unhurried, sluggish; 2. delay,

postpone, put off; 3. relaxed, not tense; 4. revive,

recuperate, come to. " These definitions are taken

from the New Age Chinese-English Dictionary published

by The Commercial Press in Beijing, 2000.

 

Now, none of these definitions means " normal. "

As I pointed out, there is a distinct term,

zheng4 chang2, that means normal and is used

in Chinese to refer not only to a normal pulse

but to anything that is normal. It is also

the term you find if you look up " normal pulse "

in the Practical Dictionary.

 

So I'm wondering why you chose to use a term

that does not mean normal to mean normal. I do

definitely agree that this is the reason why

people get confused, i.e. the misuse of terms.

>

> 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.

 

Thanks. It looks quite interesting. I'll study

it carefully.

 

Ken

[Guest guest]

Ken:

 

You're correct, I was refering to the wrong pinyin. I'll change it.

Thanks.

 

Jim Ramholz

 

 

 

, yulong@m... wrote:

> Jim,

>

> > Huan mai is from the Wiseman dictionary, of course.

>

> But is not the term you find if you look up " normal pulse. "

>

> 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.

>

> As I read this quote from the Practical Dictionary

> it means, if you construe a moderate pulse as normal,

> which I would take to imply an instance where no

> other pathological changes were present, then it

> simply reflects the presence of stomach qi4. When,

> on the other hand, a moderate pulse is felt in

> the presence of dampness patterns or cases of

> spleen-stomach vacuity, it is indeed a diagnostic

> indication of those conditions.

>

> > You can't have it

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

by

> > CM.

>

> Indeed. Except, as I read the current confusion

> it is one that you have introduced by redefining

> one term to mean another. The Chinese word huan3

> means " 1. slow, unhurried, sluggish; 2. delay,

> postpone, put off; 3. relaxed, not tense; 4. revive,

> recuperate, come to. " These definitions are taken

> from the New Age Chinese-English Dictionary published

> by The Commercial Press in Beijing, 2000.

>

> Now, none of these definitions means " normal. "

> As I pointed out, there is a distinct term,

> zheng4 chang2, that means normal and is used

> in Chinese to refer not only to a normal pulse

> but to anything that is normal. It is also

> the term you find if you look up " normal pulse "

> in the Practical Dictionary.

>

> So I'm wondering why you chose to use a term

> that does not mean normal to mean normal. I do

> definitely agree that this is the reason why

> people get confused, i.e. the misuse of terms.

> >

> > 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.

>

> Thanks. It looks quite interesting. I'll study

> it carefully.

>

> Ken

[Guest guest]

I've been taught that one of the curious featuresof traditional Chinese medicine is that if youtake 10 (or even 20) competent doctors and letthem all examine one patient, you will find that there may be little in the way of agreementamong the doctors as to what is wrong or howto go about dealing with it. Yet many if notall of these differing approaches may provesuccessful in alleviating the condition.>>>>Doest this point to the interaction as being what is healing and not the actual medicine

Alon

[Guest guest]

James,

 

There are several of the 28 pulse images which have two definitions,

one when the term is applied to a healthy (ping) pulse and another

when it is applied a disease (disease) pulse. I don't see any

particular problem with that, and my Chinese teachers have been clear

to point this fact out when introducing these particular pulse images.

The interpretation of the term depends on the context within which it

is used. Similarly, the words " cool " and " great " have two very

different meanings in English depending on the context. Yet neither

meaning negates the other.

 

Based on my review of the premodern and contemporary Chinese language

literature on the pulse, I would say that, when the term huan mai is

used as a descriptive of a healthy pulse, it especially means that the

pulse is not rapid and not bowstring or stringlike. When it is used as

a descriptive of a diseased pulse, it means that the pulse is slightly

slow, i.e., relaxed.

 

This is one place where Wiseman's terminology does not, in my opinion,

do an adequate job. As a teacher, it is my experience that many

English-speakers are confused by this term, " moderate " pulse. That's

why, in my own teaching and writing, when I mean huan mai as one of

the diseased pulse images, I typically say " moderate " and then put

" i.e., relaxed or slightly slow " in parentheses, thus using Wiseman

for my standard identification but glossing that term to help bring

out its technical meaning in that particular context. I believe most

of the students to whom I have taught pulse exmaination understand and

keep these two meanings disinct in their minds without any particular

difficulty. I merely say, like my teachers in Shanghai, that this

pulse has two different meanings depending on how and when the term is

used. This also holds true for the replete (shi) and vacuous (xu)

pulses which have two different definitions depending on their

context.

 

Bob

 

, " James Ramholz " <jramholz> wrote:

> 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

[Guest guest]

Bob:

 

Thanks for your thoughts. But in this instance, Ken is very helpful

(good editors are hard to find). My reason for wanting to change the

term is for the some of the very reasons you mention, and others. I

was looking for a unique definition of a normal pulse, and had

overlooked Zheng chang mai----even though it is in the Wiseman

dictionary, too. The problem of synonyms and their definitions is

even more of a pressing problem for me when trying to coordinate the

Korean concepts in Chinese terms with the Chinese concepts in Chinese

terms, and then into a reliable and coherent system in English terms.

 

For example, our system is influenced by Bian Que quite a bit. Even

though normal is written as the Chinese character ping in the Mai

Jing section on Bian Que, I didn't want to introduce too many

synonyms for normal without first trying to connect the physical

sensation of examining the pulses to wider yin/yang theory. An

important example of differences in Korean and Chinese concepts is

regarding the knotting (jie) movement. In our system, knotting has a

unique 3-dimenisonal spiral character---not simply interupted. And

there are a number of other terms that should be renamed to

distinguish them from their common use in Chinese literature. Jiang

Jing would argue that his were the real meanings---unfortunately he

kept his system as secret as it was sophisticated. I am trying to

make his system accessible and coherent in English, and avoid many of

the mistakes found in the translation of Chinese literature.

 

The Korean system I studied was fairly intelelctually isolated from

mainstream TCM---even to the extent that Jiang Jing wanted to bring

the " real " acupuncture back to China. We primarily work in 5-Phases,

6 Energies, and use many Western concepts because our pulse system---

our main, almost exclusive, method of diagnosis---is organized this

way. For example, in our pulse system we have an endocrine gland

depth (identifying endocrine glands as in Western terms) where we can

distinguish between pancreatic function and the spleen or stomach, in

the right middle position (so you can often predict the lab results

about their functioning).

 

We don't use Zang-fu or 8-Principles much more than just background

data. I had to study zang-fu and 8-Principles for the NCCA exam in

1985, and then relearn it to participate in discusssions with fellow

practitioners and students at school when I teach. Many of our pulse

observations and diagnosis have to do with the interactions between

organs or other parts of the body; even between noncontiguous pulse

sectors. In our system, the Zang-fu notion of arriving at spleen

depletion (pi xu) or liver excessiveness (gan shi) as a diagnosis are

ambiguous and only descriptive at best---too many varied disorders

have the same " diagnosis. " They don't show the real dynamic

interaction of living systems or how they arrived in that state. Much

of that information, I know, is accessible to CM through questioning

and other types of examination, but we try to do it all through the

pulse. Jiang Jing hardly talked to his patients before examining

their pulses; I still have to talk to mine a little.

 

Jim Ramholz

 

 

 

 

 

 

James,

 

There are several of the 28 pulse images which have two definitions,

one when the term is applied to a healthy (ping) pulse and another

when it is applied a disease (disease) pulse. I don't see any

particular problem with that, and my Chinese teachers have been clear

to point this fact out when introducing these particular pulse

images.

The interpretation of the term depends on the context within which it

is used. Similarly, the words " cool " and " great " have two very

different meanings in English depending on the context. Yet neither

meaning negates the other.

 

Based on my review of the premodern and contemporary Chinese language

literature on the pulse, I would say that, when the term huan mai is

used as a descriptive of a healthy pulse, it especially means that

the

pulse is not rapid and not bowstring or stringlike. When it is used

as

a descriptive of a diseased pulse, it means that the pulse is

slightly

slow, i.e., relaxed.

 

This is one place where Wiseman's terminology does not, in my

opinion,

do an adequate job. As a teacher, it is my experience that many

English-speakers are confused by this term, " moderate " pulse. That's

why, in my own teaching and writing, when I mean huan mai as one of

the diseased pulse images, I typically say " moderate " and then put

" i.e., relaxed or slightly slow " in parentheses, thus using Wiseman

for my standard identification but glossing that term to help bring

out its technical meaning in that particular context. I believe most

of the students to whom I have taught pulse exmaination understand

and

keep these two meanings disinct in their minds without any particular

difficulty. I merely say, like my teachers in Shanghai, that this

pulse has two different meanings depending on how and when the term

is

used. This also holds true for the replete (shi) and vacuous (xu)

pulses which have two different definitions depending on their

context.

 

Bob

[Guest guest]

>It's also one of the factors that makes

>Chinese medicine virtually impossible to

>test using the methodology of the double

>blind randomized control trial

 

It is not impossible to use gold standard clinical trial protocols in

assessing TCM under ALL circumstances. Even many studies evaluating

pharmaceutical drugs with these clinical trials constraints proves quite

difficult. Outcomes as well as physiological end point measurement based

studies can and have been undertaken successfully using Chinese herbal

formulas. The placebo effect is not necessarily the same as what is gained

from a doctor with what's referred to as good bedside manner. I believe

placebo is often a reflection of the power of hope over despair. An

effective treatment should be able to improve upon the effect of " mere "

hope, to offer at least a subjective improvement value greater than placebo.

Otherwise, why all the differential diagnosis and careful selection of

herbs?

 

 

 

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]

--- yulong wrote:

> Alon,

>

> , <alonmarcus@w...>

> wrote:

> > 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.

> > >>>>Doest this point to the interaction as being

> what is healing

> and not the actual medicine

>

>

> My take on this is that the interaction, as

> you're calling it (others use the term " placebo

> effect " I think to describe similar and/or

> related aspects and issues) constitutes

> the baseline of " the actual medicine. "

>

> I think it is one of the potent attractors

> of Chinese medicine, especially in a

> highly mechanized health care environment

> where the interaction between doctor and

> patient has been reduced to a subject

> monitored by lawyers and accountants

> rather than by the doctors and patients

> themselves.

>

> It's also one of the factors that makes

> Chinese medicine virtually impossible to

> test using the methodology of the double

> blind randomized control trial, which is

> based on a model of statistical inference

> developed in the 19th century to test

> the efficacy of fertilizers.

>

> Ken

>

>

 

 

 

 

Make a great connection at Personals.

http://personals.

[Guest guest]

My take on this is that the interaction, asyou're calling it (others use the term "placeboeffect" I think to describe similar and/or related aspects and issues) constitutesthe baseline of "the actual medicine."I think it is one of the potent attractorsof Chinese medicine, especially in ahighly mechanized health care environmentwhere the interaction between doctor andpatient has been reduced to a subjectmonitored by lawyers and accountantsrather than by the doctors and patientsthemselves.>>>>The bigger question then becomes should one spend the time to study the medicine or cultivate interactive skills.

Alon

[Guest guest]

The placebo effect is not necessarily the same as what is gainedfrom a doctor with what's referred to as good bedside manner.

>>>>The question is there something more than the so called placebo effect which assumes "just the power of belief" or a good interaction can actually do more.

Alon

[Guest guest]

Alon,

 

> >>>>The bigger question then becomes should one spend the time to

study the medicine or cultivate interactive skills.

 

The principal interactive skill, of course,

is actually doing something effective for

the patient. I think that trying to separate

these two aspects of clinical intervention

is an error, as Antonio Damasio might call

it, Descartes' error, i.e. it seems to me

a reflection of the mind-body schism that

is so notably present in Western thinking

and no notably absent from Chinese thinking.

 

What I meant by " baseline " in my earlier

post in referring to what is often known

as " the placebo effect " is that without

the fundamental communication dynamics

of the diagnostic interview, for example,

the whole clinical intervention would

lack continuity in much the way that

the baseline of a piece of Baroque music,

the basso continuo, provide the sustenance

of the whole composition.

 

The connectivity between doctor and patient

is an opportunity for their qi4 to mingle.

And it is this mingling of qi4 that serves

the therapeutic aims of both, whether it

be in the form of conversation, an herbal

formula, a well placed needle or any of

a number of other aspects of the interaction.

 

So with respect to the relative size of questions,

I'd say that the big one is how do we cultivate

ourselves to become whole in such a way that

this wholeness encompasses both the minutiae

of medical knowledge and the overarching

concern for our shared fate as human beings.

 

 

Ken

[Guest guest]

The connectivity between doctor and patientis an opportunity for their qi4 to mingle.And it is this mingling of qi4 that servesthe therapeutic aims of both, whether itbe in the form of conversation, an herbalformula, a well placed needle or any ofa number of other aspects of the interaction.So with respect to the relative size of questions,I'd say that the big one is how do we cultivateourselves to become whole in such a way thatthis wholeness encompasses both the minutiaeof medical knowledge and the overarchingconcern for our shared fate as human beings.>>>>That is probably very true and again brings into question the relative importance of technical aspects of the medicine.

Since the whole concept of placebo is in question and probably only reflects the natural course of many disorders as well as homeostasis and our ability to enhance self healing with attitude. One wanders were is ones time best spent. Reading classics and technical books or enhancing skills of simple clinical interchange. It is very interesting to see practitioners that are techniqually very poorly trained getting better results than well trained just because of bedside manner. I have seen very many smart technicians/physicians fail at making a practice while true air heads and do not have a chance of doing a differential diagnosis do very well.

Alon