Pulses - what else?

[Guest guest]

Hi Al -

 

Two years ago I asked about this pulse and got very little response for

reasons that escape me. I would say that your portrayal of the three aspects of

a

choppy pulse (se mai) are consistently Beijingesque and so state approved...and

I don't express that with pejorative intent. A great many deep thinkers

focused on the arrival at that set of standards. By the way, Ma Xiuling is a

significant representative of that August institution.

 

>

> 1) inconsistent in amplitude and/or strength.

>

> 2) pulse shape has rough steps to it. Imagine the smooth up and down of

> the slippery pulse, then add stair steps. That's the second type of

> choppy and the one that I'm most familiar with.

>

> 3) The so-called " three - five " pulse which is inconsistent in speed

> (three beats per breath, then five beats per breath...)

>

 

Here is a list of authoritative opinions about this 'se mai':

 

 

 

Jin Wei: " this is a pulse that is felt fine,slow, short, scattered, hesitant,

and unsmooth, like scraping bamboo with a knife. "

 

 

 

Maccioccia: " This pulse feels rough under the finger: instead of a smooth

pulse wave, it feels as though it had a jagged edge to it. Choppy also indicates

a pulse that changes rapidly both in rate and quality " - (by the way the first

sentence of this interpretation is very consistent with the opinion of Dr

John Shen and that of Leon Hammer).

 

 

 

Li Shizhen: “A pulse which feels thin, minute and short and has an uneven

flow, beating three and five times with irregular rhythm, is called

choppy.....It

feels like a knife scraping bamboo, rough and jagged. It is easily scattered

like rain falling onto the sand. It also moves very slowly and at irregular

depths, like an ill silkworm eating a leaf.â€

 

 

 

Wang Shuhe: “a fine and slow pulse, coming and going with difficulty and

scattered or with an interruptionâ€

 

 

 

Kaptchuk: irregular in rhythm. In this case it is called the three and five

not adjusted sometimes three beats per breath and sometimes five beats per

breath.

 

 

 

Wu Shuiwan: " The movement of this pulse is felt as rough and choppy. It is

not fluent. It is slow and thin. The wave of this pulse is short. "

 

 

 

Deng Tietao: " it should feel slow and uneven, fine, small, short. "

 

CAM: " A hesitant pulse feels rough and uneven " ......and... " stagnations

produce a hesitant and forceful pulse " whereas " insufficiency creates a hesitant

and weak pulse "

 

>

> Simply this: Bob Flaws teaches the three-five pulse as one of the many

> expressions of the se mai (choppy, hestitant, etc.) while Ma, Xiu-ling

> has never heard of this definition.

>

 

The English translation of Li Zhishen and Kaptchuk also confirm the '3 and 5

pulse' which is changing rate at rest. In my experience this pulse can be due

to blood stasis or essence depletion. However, it is more commonly due to

various forms of emotional instability. A recent exception to this in my

clinical

experience is a patient with cardiomyopathy and ventricular tachycardia whose

rate changes from 62bpm to 104bpm and the cause is organic. The diagnosis

however, is kidney yang depletion and the prescription is Zhen Wu Tang.

 

 

 

William R. Morris, L.Ac., O.M.D.

Secretary, AAOM

Dean of Educational Advancement

Emperor's College of Oriental Medicine

310-453-8300 phone

310-829-3838 fax

will

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[Guest guest]

, WMorris116@A... wrote:

> Hi Al -

>

> Two years ago I asked about this pulse and got very little response for

> reasons that escape me.

 

Will

 

Though you don't state this explicitly, the range of descriptions of the choppy

pulse you give, some of which are quite qualitative, implies to me that

students must indeed be calibrated by a particular practitioner in order to

reliably identify this pulse. The 3-5 description is quantitative and thus more

easily calibrated. However I was trained more along the lines exemplified by

the following quotes you provide:

 

Wang Shuhe: a fine and slow pulse, coming and going with difficulty and

scattered or with an interruption

 

Wu Shuiwan: " The movement of this pulse is felt as rough and choppy. It is

not fluent. It is slow and thin. The wave of this pulse is short. "

 

Deng Tietao: " it should feel slow and uneven, fine, small, short. "

 

Using these descriptions, I think demonstrationis essential for recognition.

What do you think?

 

[Guest guest]

, WMorris116@A... wrote:

 

> >

> > Simply this: Bob Flaws teaches the three-five pulse as one of the many

> > expressions of the se mai (choppy, hestitant, etc.) while Ma, Xiu-ling

> > has never heard of this definition.

 

 

How could someone have not heard of the 3-5 definition as it is in Li Shih

zhen?

 

[Guest guest]

> Using these descriptions, I think demonstrationis essential for recognition.

> What do you think?

>

 

 

Agreed, but these are poorly written, tactiley ambiguous definitions. Just

because many Chinese are also confused about the pulses

does not mean that there cannot be clarity and objective standards in this

method of examination.

 

When I wrote my pulse book, I poured over dozens if not scores of Chinese books

and journal articles on the pulse until I was able to

find unambiguous, tactile definitions that also made sense in terms of the pulse

images indications and those indications underlying

disease mechanisms. One has to know what to focus on and what is merely part of

the traditional convention of transmission. In

translation, this is the issue between the words and the meaning or between the

text and the commentary.

 

Bob

[Guest guest]

Ever hear of the " lost generation " in China? Anyone who finds it curious that a

supposed Chinese authority is ignorant of something

that should be well known needs to bone up on Chinese history during the

Cultural Revolution and afterwards. ( I don't

mean you personally. This is a rhetorical device.) There's a whole generation of

functional illiterates who are now at the top of the heap

in terms of their professional standing. This is exactly why one needs to be

very careful about accepting Chinese people as authorities

simply because they are Chinese. One has to look at each individual's

credentials, where they studied and when, who they studied

with, etc. Then one also has to somehow gauge their relative intelligence. In

other words, one has to be an informed consumer. Caveat

emptor. This is why reading the Chinese medical literature widely is so

important. In my experience, it helps one gain perspective.

You've got to be able to survey the whole field or at least a good portion of it

in order to gauge the relevance of any particular hill or

valley.

 

Bob

[Guest guest]

If this is in reference to the doctor who didn't know the 3-5 pulse I can assure

you

she is too yong to be part of the " lost generation " . I would say that perhaps Al

made a

bad presentation of the pulse to her.

doug

 

 

, " Bob Flaws "

<pemachophel2001> wrote:

> Ever hear of the " lost generation " in China? Anyone who finds it curious that

a

supposed Chinese authority is ignorant of something

> that should be well known needs to bone up on Chinese history during the

Cultural

Revolution and afterwards. ( I don't

> mean you personally. This is a rhetorical device.) There's a whole generation

of

functional illiterates who are now at the top of the heap

> in terms of their professional standing. This is exactly why one needs to be

very

careful about accepting Chinese people as authorities

> simply because they are Chinese. One has to look at each individual's

credentials,

where they studied and when, who they studied

> with, etc. Then one also has to somehow gauge their relative intelligence. In

other

words, one has to be an informed consumer. Caveat

> emptor. This is why reading the Chinese medical literature widely is so

important.

In my experience, it helps one gain perspective.

> You've got to be able to survey the whole field or at least a good portion of

it in

order to gauge the relevance of any particular hill or

> valley.

>

> Bob

[Guest guest]

On Apr 8, 2004, at 10:01 AM, wrote:

 

> How could someone have not heard of the 3-5 definition as it is in Li

> Shih

> zhen?

 

A Russian friend of mine had trouble understanding why I couldn't tell

him where any bard festivals were in the USA. I didn't know what a bard

was, let alone where they would get festive. I later learned that bard

is an English (i.e. England) word for a sort of folk

singer/balladeer/poet.

 

" How could I not know an English word? " He asked.

 

" I'm not from England. " was my response.

 

Had he asked me where the local bluegrass, jazz, or blues festivals

are, I might have had a better answer for him.

 

I give Dr. Ma a lot more credit in terms of her TCM than most I've run

into in this business, but I will agree with Doug in the possibility

that I didn't adequately describe the concept to her.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

On Apr 7, 2004, at 7:55 PM, WMorris116 wrote:

 

> Hi Al -

>

> Two years ago I asked about this pulse and got very little response for

> reasons that escape me. I would say that your portrayal of the three

> aspects of a

> choppy pulse (se mai) are consistently Beijingesque and so state

> approved...and

> I don't express that with pejorative intent. A great many deep thinkers

> focused on the arrival at that set of standards. By the way, Ma

> Xiuling is a

> significant representative of that August institution.

>

>>

>> 1) inconsistent in amplitude and/or strength.

>>

>> 2) pulse shape has rough steps to it. Imagine the smooth up and down

>> of

>> the slippery pulse, then add stair steps. That's the second type of

>> choppy and the one that I'm most familiar with.

>>

>> 3) The so-called " three - five " pulse which is inconsistent in speed

>> (three beats per breath, then five beats per breath...)

>>

>

> Here is a list of authoritative opinions about this 'se mai':

>

>

>

> Jin Wei: " this is a pulse that is felt fine,slow, short, scattered,

> hesitant,

> and unsmooth, like scraping bamboo with a knife. "

 

This is consistent with the character 'se4' ~{I,~}, which is the image of " a

knife or blade over a foot, combined with the water radical.

>

>

>

> Maccioccia: " This pulse feels rough under the finger: instead of a

> smooth

> pulse wave, it feels as though it had a jagged edge to it. Choppy also

> indicates

> a pulse that changes rapidly both in rate and quality " - (by the way

> the first

> sentence of this interpretation is very consistent with the opinion of

> Dr

> John Shen and that of Leon Hammer).

 

Giovanni quotes John Shen quite a bit in his new diagnosis text (in the

pulse section).

>

>

>

> Li Shizhen: ~{!0~}A pulse which feels thin, minute and short and has an

> uneven

> flow, beating three and five times with irregular rhythm, is called

> choppy.....It

> feels like a knife scraping bamboo, rough and jagged. It is easily

> scattered

> like rain falling onto the sand. It also moves very slowly and at

> irregular

> depths, like an ill silkworm eating a leaf.~{!1~}

 

This is rich in metaphor. It is difficult to standardize metaphor when

creating standards of practice, and this is a problem. Metaphors are

great teaching tools, and also great ways of communicating clinical

information to patients. I find metaphor to be a great tool, and

Chinese medicine is rich in metaphor, lest we forget. I agree

wholeheartedly with Todd and Bob Flaws that we need a standard pulse

reference, at least for the 28 or so pulse qualities, so that there can

be inter-professional communication. However, at the same time, we are

going to miss the boat if we rely just on basic definitions. As your

quotations point out, there are many aspects to a choppy pulse, and

that qualities are always going to be more subtle than quantities to

measure. I think this is one of the reasons for confusion in defining

the choppy/rough pulse.