Evolution of Pulse Diagnosis

[Guest guest]

I came across an essay that I wrote awhile back that might be of

interest to some:

 

The Dynamic Evolution of Pulse Diagnosis

By Feng Ye and Eric Brand

 

Evaluation of the pulse has been one of the most important aspects of

Chinese medical diagnosis throughout history. From ancient times

until the modern day, the pulse has been regarded as Chinese

medicine¡¯s most comprehensive and reliable diagnostic indicator.

Experienced practitioners can detect ovulation, pregnancy, and common

colds in their regular patients; some can even pinpoint a new

patient¡¯s chief complaint by the pulse alone. Although many

Westerners find the intricate assessment of the pulse to be one of the

most intriguing features of Chinese medicine, we are largely unaware

of the historical influences that have shaped our modern understanding

of pulse diagnosis.

 

Pulse diagnosis as we know it today is very different than it was at

its inception. In the modern age, practitioners rely exclusively upon

the radial artery when evaluating the pulse. However, the use of the

radial pulse to diagnose visceral conditions was preceded by several

other methods of pulse diagnosis. Previous historical periods

assessed different conditions and utilized different sites of

palpation than we find in the modern day. A variety of factors caused

the sites of palpation to change over the ages, and the perception of

what the pulse can reveal has evolved to accommodate developments in

general medical theory. A brief exploration of this fascinating

process is outlined below.

 

The earliest known references to pulse diagnosis were found in a

nobleman¡¯s burial chamber known as Ma Wang Dui, dating back to the

early Han Dynasty (168 BCE). At this time, symptoms and diseases were

correlated with specific channels and pulses. Although the emphasis

is clearly centered on pathoconditions of the channels, a case can be

made that the silk records found at Ma Wang Dui illustrate the

earliest recorded integration of pulse, pathoconditions, and

diagnosis. At this point in history, pulse diagnosis was not yet

influenced by five-phase theory or visceral theory.

 

When the works at Ma Wang Dui were written, there were eleven channels

and disease was primarily based upon channel associations rather than

visceral origins. Each channel had its own pulse, which was located

at a given point on the channel; there were not yet any single points

that reflected the pathology of more than one channel. Unusual

stirring at the palpation sights indicated disease of the

corresponding channel. The various channels were not yet perceived to

be linked together, and the channels were labeled with names such as

the ear channel and the cheek channel, rather than the modern

classification that we find today.

 

Pulse diagnosis had evolved considerably by the time the Huang Di Nei

Jing (¡°The Yellow Emperor¡¯s Inner Canon¡±) was written in the later Han

Dynasty. At this point in history, Chinese medicine had a clear

influence of five-phase theory and visceral manifestation, as well as

the twelve channel system that is in use today. The channels were

linked with each other, and the concept of ¡°stomach qi¡± arose to

explain how the various channels were connected and carried to the

radial pulse. The theory of ¡°stomach qi¡± explained how the wrist

pulse could supply information about a variety of organs and channels,

and the presence of stomach qi in the pulse is regarded as an

important feature of pulse diagnosis to this day.

 

Another important aspect of pulse diagnosis during the time of the

Huang Di Nei Jing involved the comparison of the radial pulse with the

pulse of the carotid artery, which was taken at the acupoint ren ying

(Man¡¯s Prognosis, ST-9). Determining the strength of the carotid

pulse relative to the radial pulse allowed a practitioner to determine

which channel a disease was located in. Interestingly, although the

radial pulse was assigned a variety of pulse qualities, at this time

it was palpated with a single finger. The quality of the pulse

determined the location of disease, with each quality specifically

assigned to a given channel. This stands in contrast to the modern

diagnostic method, which uses the pulse quality to determine the

nature of a disease and different locations on the wrist pulse to

determine its location.

 

We find still more clues about the evolution of pulse diagnosis in the

Shang Han Lun (¡°On Cold Damage¡±), which was written in the Han Dynasty

after the Nei Jing. Zhang Ji, the author, mentions that by his time,

few physicians were taking the pulse at the older locations of ren

ying (ST-9) and the pedal pulse. It is suspected that increasingly

conservative attitudes about appropriate touch limited doctors from

palpating women¡¯s pulses at the femoral artery and other regions, thus

causing physicians to focus their efforts exclusively on the radial

pulse. During some dynastic periods, women were kept behind dressing

screens and the doctor was only able to palpate the pulse by having

her place her cloth-covered wrist through a slot in the screen.

Although such influences caused the ancient pulse techniques to go

largely undeveloped, they undoubtedly fueled the advancement of

diagnosis using the radial artery alone.

 

Zhang Ji did not differentiate the pulses between the left and right

sides. Assigning certain bowels and viscera specifically to the right

and left sides appears to be a later development, and the proposed

location of some of the bowels and viscera changed over time.

Similarly, the concept of using three fingers to take the pulse was a

later development, one that is only conclusively evident in the Tang

Dynasty works by Sun Si-Miao. Sun Si-Miao¡¯s Qian Jin Yao Fang (¡°A

Thousand Gold Pieces Prescriptions¡±) text, written in the 7th century,

also provide us with the earliest indisputable evidence that the

bowels were assigned to the more superficial level of the pulse, while

the viscera were assigned to the deeper positions.

 

However, Sun Si-Miao¡¯s works were preceded by the influential Mai Jing

(¡°The Pulse Canon,¡± 3rd century CE), written in the Jin Dynasty by

Wang Shu-He. This text provides many of the classical descriptions of

pulse qualities that are studied to this day. While many different

pulse qualities had been named before (over 50 are mentioned in the

Nei Jing), many of the pulses named were similar and many were poorly

defined.

 

Wang Shu-He¡¯s Mai Jing provided descriptions of 24 out of the 28

pulses that are used today. By the time of Li Shi-Zhen in the 16th

century, we can see 27 of out the 28 pulse qualities that are used in

modern times. The final quality, the racing pulse (ji mai), became

integrated only in the Qing Dynasty (1616¨C1911 CE).

 

It is speculated that numerology may have influenced the number of

pulse qualities assigned. 28 is a ¡°divine number¡± in Chinese

numerology; the Chinese recognized 28 constellations in the sky and

may have linked the number of pulse qualities with the divine number

28 to reflect their perceived links between the celestial world and

the mundane world. The influence of ¡°divine numbers¡± is most clearly

evident in early methods of pulse diagnosis, which made three

different groupings of pulses based on the location of the arteries

and the associated correspondences with heaven, earth, and man.

 

The gradual evolution of pulse diagnosis offers us insight into the

way ancient Chinese physicians perceived health and illness. Some

concepts have remained relatively consistent despite the passage of

time, yet the changes that are evident in early texts show us that

pulse diagnosis adapted dynamically as Chinese medicine developed.

Unfortunately, the ancient methods of palpating a variety of sites

never had the opportunity to flourish and provide us with a complete

system for use in the modern day. However, whatever factors caused

these techniques to diminish in prominence allowed for the development

of an extremely sophisticated method of diagnosis based upon the wrist

pulse. Although ancient techniques may not always provide us with

increased clinical utility, they provide us with insight into the

process that allowed Chinese medicine to become the complex and

intriguing art that it is today.

[Guest guest]

, " Eric Brand "

<smilinglotus wrote:

The channels were

> linked with each other, and the concept of ¡°stomach qi¡± arose to

> explain how the various channels were connected and carried to the

> radial pulse.

 

Sorry, this concept is called " stomach is the sea of the twelve

channels. "

 

Eric