The essence of the traditional Chinese medicine has always been the most advanced and experienced therapeutic approach in the world.
For the post on tongue diagnosis, I used a picture of our bulldog, Pugsley, and his tongue. He also has a regularly irregular heart beat, but we have never bothered with an EKG. His pulse skips every third beat. I imagine his EKG would look somewhat like the one featured above.
So does my dog have Dai Mai (Regularly Intermittent) pulse? It is not intermittent, but would mean a
Decline of Zang Fu (organ) Qi, Wind Syndromes, Pain, Terror, Fear, Trauma.
His wind, when broken, can inspire terror and fear. I do not think that is what is meant. But,
Flaws: “Patients with this pulse have advanced heart disease according to western medicine and should be immediately referred to a western doctor” AKA someone who actually understands cardiology.
or is it Cu Mai (Rapid-Irregular, Skipping, Abrupt) pulse, due to
Excess Heat, Domination of Yang, Qi, Blood, Phlegm and Food Stagnation. This can be from an Atrial Fibrillation.
and
This is clinically very severe, Yin and Yang are not in communication.
I wonder, does cardioversion bring Yin and Yang back into communication? Is food stagnation an indication for Eliquis? Can you do TCPM pulse diagnosis on dogs?
Perhaps I should dig deeper into that most advanced and experienced therapeutic approach in the world.
I have always had a watch with a second hand, which, it occurs to me, is the third hand. The minute hand is the second hand, with the hour hand being the first. English. What are you going to do? Anyway, I always wanted to be able to count a patient’s pulse or respiration myself.
Not that the pulse was all that important in most patients. Lack of pulse? That can be a big deal, especially combined with lack of respiration. As an infectious disease doctor, the only fun manifestation of measuring a pulse was Faget’s sign, pulse temperature disassociation. For every degree the body temperature goes up, pulse should go up about 10 beats. At least for those not on
beta blockers. There are a half-dozen infections where the pulse does not go up with the fever, first recognized by Dr. Faget while studying Yellow Fever. I have found it a useful hint as to the eitiology of some infections.
Taking the pulse, while interesting, is not that important in making a diagnosis in modern medicine. Fast, slow, irregular, are all features that could warrant further evaluation as to the reason for those abnormalities. With, say, an EKG. And modern diagnostics have resulted in some physical findings being more entertaining than helpful, as physical findings often lack sensitivity and specificity. I don’t think I would recognize a water hammer pulse despite seeing no end of aortic insufficiency in my career. I relied on the ECHO to know what was actually going on with the aortic valve.
In Tradition Chinese Pseudo-Medicine (TCPM), it is different. When combined with tongue evaluation, the examination of the pulse is a critical part of making a diagnosis. Well, making a TCPM diagnosis. So not that impressive, as using fiction based diagnostics to diagnose fictional problems is less than remarkable.
TCPM is not the only pseudo-medicine that uses the pulse for diagnosis, as, in a different forms, pulse is used in Ayurveda, Korean, and other medical traditions. And, of course, each style does not agree in the particulars.
TCPM has two different characteristics for pulse diagnosis. One form is based on the quality of the pulses, the other on mapping organs to the area of the pulse. Of course. There is always multiple way to skin a cat sith.
A problem in discussing TCPM pulse diagnosis, like all pseudo-medical practice, is since they are not based on reality, there is no real standard to determine sensitvity or specificty of the diagnosis. There are likely as many forms of acupuncture as there are acupuncturists since there is no objective basis for the practice. The same is true to TCPM pulse diagnosis. There are likely as many forms as there are practitioners and there is very little agreement between practitioners.
One description of the manuever is as good as any:
A TCM doctor palpates six locations, three on each wrist, with the three points called “cun”, “guan”, and “chi”, and describes pulses in terms of various characteristics. By comparing the pulses at left and right cun, guan, and chi, the health status of individual organs and of the whole body can be determined. As specified in the ancient texts, the Nan Jing and Mai Jing, the heart, liver, and kidneys lungs, spleen, and kidneys are assessed at the right cun, guan, and chi, respectively.
As in the above example, the spleen in mapped to the middle pulse of the right hand. It is also mapped to the foot, the ear, the hand, and the body in various forms of acupuncture. The spleen sure gets around. why is the spleen on the right and not the left? I wonder if that is reversed in situs inversus. As best I can determine, no TCPM practitioner has evaluated the idea.
Maya pulse diagnostics, while done differently by its last practitioner, Don Elijio also has 28 different pulses as well (an observer tried to overlay TCPM on to Don Elijio’s system, with variable success), but he could diagnose 42 conditions including spirit possession and witchcraft, as well as a variety of wind conditions.
Don Elijio also would use his thumb at times to palpate the pulse, which is a no-no in medicine as you run the risk of feeling your own pulse and the thumb is not as sensitive.
Why the wrist? Why not one of the many parts of the body where the pulse can be felt? In ancient times other pulses were palpated, but these have faded in usage over time. Why? And why do I continue to try and apply reason, logic, and reality to a complicated work of fiction?
It is the nature of the pulse that is important in the diagnosis:
The most common 28 TCM pulse qualities were used in clinical practice come from the references Bin Hu Mai Xue and Zhen Jia Zheng Yan. These qualities are floating, sunken, slow, rapid, surging, fine, vacuous, replete, long, short, slippery, rough, string-like, tight, soggy, moderate, faint, weak, dissipated, hollow, drum skin, firm, hidden, stirred, intermittent, bound, skipping, and racing.
Some sources say there are 29 pulses. No pulse would be the 29th?
Like much of TCPM, how pulse diagnosis was done back in the day was different than currently practiced:
Present-day finger placement on the radial artery for pulse diagnosis to determine the relationship between organs and general condition vary according to widely used Chinese or Tibetan method. Variations exist between different historical Chinese periods on finger organ representation points and vary to minimum extent among Tibetan historical and current writers. Present-day finger placement on the radial artery for pulse diagnosis to determine the relationship between organs and general condition vary according to widely used Chinese or Tibetan method. Variations exist between different historical Chinese periods on finger organ representation points and vary to minimum extent among Tibetan historical and current writers.
Modern TCPM practitioners do recognize they do not really understand what they are doing:
These pulse qualities are largely described qualitatively and are not clearly defined. For instance, the slippery is compared to “beads rolling” and the string-like is like pressing the string of a musical instrument. The magnitude of a pulse quality is, similarly, not precisely defined. The difference between a fine pulse and a faint pulse is that the former is a “little bit stronger” than the latter. “A little” does not precisely determine what differentiates fine from faint. Thus, descriptions of pulse are subject to the interpretation of individual doctors, and this lack of quantitative standardization undoubtedly contributes to the low inter- and intra reliability among TCM doctors.
And, as one video has it, how to take a pulse is a matter of style. Of course it is. Can’t have a standard when each practitioner makes it up as they go along. But at least a given practitioner often makes it up the same way each time:
Testers tended to agree with themselves more often than they did with others when rating the same patient’s pulses.
Different types of pulse have different meanings. For example, a hollow pulse?
It means that there is still some flow of qi at the vessel surface, but not much blood.
A hurried pulse?
On the one hand, this can represent contraction of the qi, as in liver qi stagnation, or it can represent deficiency of the qi.
A floating pulse?
The circulation of qi and blood is focused in the body’s surface to deal with an external pathogenic agent. The internal circulation is temporarily sacrificed to assure that the pathogen is eliminated before it can enter more deeply and cause serious problems at the visceral level. Debilitated patients may show a floating pulse that is feeble, indicating the inability to retain the qi and yang in the interior due to the deficiency of the vital organs.
This is, well, gibberish. And if you look around the interwebs and the pubmeds you can find many similar examples.
That is TCPM in a nutshell. An ancient, complicated, inconsistently practiced and worthless fiction divorced from known anatomy and physiology.
So whatcha gonna do?
Not much. As best I can tell, there are few studies trying to validate TCPM pulse diagnosis by itself for real diseases, which is a good thing.
The results of pulse diagnosis rely heavily on the practitioner’s subjective analysis, which means that the results from different physicians may be inconsistent.
And, as is so frequent for fiction based medicines, trying to apply modern technology in an attempt to standardize that unstandardizable. Hey. New word. But that just results in lots of tooth fairy research trying, and failing, to bring to pulse diagnosis the rigor and reproducibility of an EKG.
Using cell phones, bionic pulse diagnosis equipment (I wonder what sound that machine makes) or
computers and AI to analyze the unanalyzable (that’s new word number two) is just silly. Can’t make a silk purse out of a sow’s ear.
Proponents of TCPM like to note the practice is 3000 years old. Hm. When was the last time you wanted something from 3000, 300 or even 30 years ago? Well, from 50 years ago, music and a classic Mustang convertible. That’s it. But I would not want the food, the engineering, the science, the transportation, the political system or the social hierarchies from 3000 years ago. The medical practice? I’ll pass.
But despite its antiquity, as of 2013, they were still trying to standardize pulse taking. In 3000 years they have not even figured out the basics:
Information on anatomy of the Cun position at wrist is lacking; whether the blood vessel taking pulse in Cun is the radial artery or the superficial palmar branch is also clinically controversial.
So they investigated. In 2019, mind you. Better late than never, right?
The objective was to investigate the boundaries and contents, and the vascular distribution and their pulse points in Cun. Thirty-two upper extremities of 16 human cadavers were investigated for dissection and observation. The boundaries, contents, and blood vessel distribution in Cun were observed; the location of pulse points in Cun was identified; the length of the superficial palmar branch in wrist pulse (L1), the pulp width of the index finger (L2), and the angle between the radial artery and the superficial palmar branch were measured.
The results?
… suggested that it could not be generalized that the blood vessel taking pulse in Cun was the radial artery or the superficial palmar branch; it might depend on the vascular distribution in Cun, the region of finger positioning, and the patient’s pulse condition.
In normal speak, make it up as you go along.
There have been a few attempts to integrate TCPM diagnosis with reality-based medicine, despite
However, the study of TCM still encounters serious challenges due to the almost irreconcilable differences from the conventional orthodox medicine (OM). There are at least two major differences between TCM and OM: patient classification and intervention methodology.
You mean diagnosis and treatment? Yep TCPM offers neither. OM does. It is why TCPM is useless.
But I can’t find any studies that are not filled with incomprehensible gibberish. As when TCPM tries to describe, say, COVID 45:
COVID-19 is located in the lung, where evil Qi first invades the body from the mouth and nose, repressing the lung Qi. In turn, the lung fails to disperse and descend, with symptoms of dry cough. The “damp evil” is heavy and viscous, blocking the Qi mechanism and causing chest tightness, body heat, and muscle soreness. “Damp evil” traps the spleen, easily injuring Yang Qi. The spleen dominates and transports water and food through the body. When the Qi fails to rise, the spleen cannot be nourished, and symptoms begin to appear, including fatigue, gastric congestion and loose stool. The spleen and stomach act as the exterior and interior of each other; hence, the spleen’s dysfunction affects the stomach’s absorption. The dampness accompanying the epidemic toxin into heat is manifested as high fever, occasional yellow phlegm, obvious asthma due to the dampness toxin, and sticky stool due to the stagnation of dampness.
One study tried to diagnose essential hypertension with pulse diagnosis and compared their accuracy to, well, a blood pressure cuff. It was inferior, no surprise, but why bother? Just use the BP cuff.
I just do not think that TCPM and reality-based medicine will ever find an area of diagnostic or therapeutic agreement.
But there is good news! Yes! Perhaps less of this gibberish is being taught.
The Oregon College of Oriental Medicine in Portland is closing. One of many.
Looks like they priced themselves out of business.
Earning a master’s degree in acupuncture at the school was expected to cost nearly $74,000 this year. Completing a graduate program in traditional Chinese medicine could cost students up to $120,000. Tuition, which ranged from $26,000 to $30,000 this year,
Creative writing degrees are considerably less and have the same foundations. At least for fantasy writers.
And yes, to answer a question at the top of the post, you can do pulse diagnosis on animals
The pulse is assessed in various locations, depending on species. Cats, dogs, goats, and sheep have their femoral pulses checked. Equine pulses are palpated using the common carotid at the base of the neck or external maxillary artery, while the ventral tail (median caudal artery) is assessed in the bovine.
In fact, the whole gamut of TCPM is inflicted on animals.
I cannot find the origin of these recommendations; I think, like most of TCPM, it is made up as they go along, mostly for convenience of palpation.
In the meantime, I will let Pugsley be.
Note.
Science magazine reccomended 10 history of science books, one of which was The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine. It compares and contrasts ancient Greek and Chinese medicine with a focus on the pulse. Meh. The history is interesting, but the author seems way to gullible about the utility and legitamacy of TCPM diagnosis and treatment.
Neither the ancient Greeks nor the past and present practitioners of TCPM had any real clue about the diagnosis and treatment disease. I would not intrust my health and well being to either. I long had an interest in the pulse. For virtually all my life I would suddenly have a burst of fast, faint pulse that would last a few minutes followed by the need to pee. Something was causing the release of atrial naturetic factor. My mom used to push on my eyes to slow the pulse. Yep. That was a thing. Even though my dad was a cardiologist, it was rare and brief enough it was never caught.
Until 20 years ago or so when it hit on rounds when I was on the cardiology unit. Rapid, faint pulse. I had them put on some EKG leads and as I was standing there looking at the monitor, a cardiologist said, “You are going to the ER.” where they gave me a dose of adenosine to get me back on into normal sinus rhythm. I still remember taching along then flat line of the montor. 1,2,3,…am I dead?… sinus. Whew.
I had an aberrant cardiac conduction pathway with a supraventricular tachycardia. They ablated the pathway and my pulse has been fine since. Neither the ancient Greeks nor the current practioners of TCPM would have any clue what was wrong with me nor how to fix it by feeling my pulse.
That is one of four diseases that could have killed me but for science based medicine. To paraphrase
The essence of Science-Based medicine has always been the most advanced and experienced therapeutic approach in the world.