The Pulse: Acupuncture Assessment (Part 4)by Thomas E. Turpen, MS, R.Ac. on 09/01/11
When someone comes to see me for a particular condition, they have usually seen a gazillion of other practitioners. They usually have seen their primary care physician, and at least one or two specialists. And many will have even seen other CAM (Complimentary and Alternative Medicine) providers, including other acupuncturists. I don't mean to imply that any of these other practitioners were less than qualified or weren't any good. Sometimes, the diagnosis was correct in the conventional sense, but the therapy was inadequate or non-existent such as in the case of tinnitus. And occasionally they do miss something. Sometimes it just helps getting a fresh perspective or someone who can just step out of the box a bit. When a patient comes to see me, their condition can be likened to a mystery; and I am the detective that must search for the clues that will help me put the pieces of the puzzle together. One of the most important clues in Oriental Medicine (OM) is the pulse.
In OM, we are looking at several things when we palpate the pulse. I feel not only the rate and the rhythm, but I am also looking at its force (i.e. how strong is the pulse). I will look at its depth (i.e. is the pulse felt at the superficial or deep levels). When I feel the pulse, I will feel with the index, middle, and ring fingers at the same time, and individually. I will feel the pulse on the right and the left side; and I will feel the pulse at different positions both in depth and along the artery.
It is more than just simply placing my fingers on the artery and feeling. It is a subtle art that takes years to master. I do all of this to begin to classify what kind of pulse the patient has (most textbooks of Traditional Chinese Medicine have standardized the pulse to 28 or 29 qualities). Identifying this quality can often be what helps me clinch the diagnosis. According to the prominent scholar and physician of TCM, Giovanni Maciocia, there are a number of clinical applications of pulse diagnosis such as:
- The pulse is often crucial to clinching the diagnosis
- It is essential to distinguish between Deficiency and Excess (syndromes)
- It is essential to determine the TCM treatment principle
- It is an indicator of an (zang fu) organ problem
- The pulse indicates disharmonies beyond the presenting patters
- The pulse can indicate an underlying Deficiency syndrome in the absence of symptoms1.
Although pulse diagnosis in OM is difficult to learn and master, it is an important skill to develop and can be the difference in what gives me the final piece of the puzzle that helps me assess and therefore properly treat my patient.
1. Diagnosis in Chinese Medicine: A Comprehensive Guide by Giovanni Maciocia. Churchill Livingston, London, 2004 pp. 457-463.