PULSE DIAGNOSIS: A CLINICAL GUIDE
by Sean Walsh & Emma King
Elsevier, hardback, 248 pages
Pulse diagnosis is an endlessly fascinating and challenging subject. In taking a pulse, we are literally 'putting our finger on the pulse' – the life force – of our patient. This is a great privilege. It is a moment in treatment that can facilitate deep connection between patient and practitioner.
How to teach this to students is another challenge. It is very hard to learn to understand and discuss the meaning of something as limitless as connecting to someone’s pulse unless we have something explicit to measure it against, and this is where Chinese medicine can come into its own. Just as the eight principles and the five elements give us an organising principle that helps us understand ourselves as human beings, so the twenty eight pulses of Chinese medicine provide us with a measure for understanding variations in the pulse and what they mean.
Pulse Diagnosis: A Clinical Guide is a really useful addition to the literature in this realm of naming and understanding the basic parameters of pulse diagnosis. It is written by two practitioners of Chinese medicine in Sydney who clearly have much experience of teaching pulses, and starts right from the beginning with simple directions for correct placement of the fingers. Each aspect of taking the pulse is illustrated with excellent diagrams and tables, and should be easily understood by the beginner. Although much of this information is not new, it is extremely detailed, and collated in a readable way that students should find approachable and clinically useful.
One of the problems encountered when teaching pulses concerns non-standard terminology. There may be many different English words for one Chinese pulse quality (for example, thin, fine and thready all mean the same thing, the xi 細 pulse), and conversely the same English word may be used for more than one Chinese pulse quality (for example the English word weak can mean both just generally lacking in force (wu li 无 力) and the pulse that is specifically deep fine and forceless (ruo 弱). This can cause a lot of confusion for students, and it is refreshing to find a book that has comprehensively addressed this difficulty. Pulse Diagnosis: A Clinical Guide is very clear about terminology, primarily using the Wiseman translations, but also mentioning other possible English translations a student might come across, and including the pinyin transliteration and Chinese characters for clarity.
Another problem is to teach students how to systematically feel for the different pulse qualities. Of course this is best done by example in the classroom; there is no substitute for a teacher taking the pulse and naming it for a student. However, this book really does give some help as to which questions to ask oneself in order to feel particular pulse qualities.
It does this by presenting the pulses in clearly defined groups, starting with those that are defined by their rate (slow, rapid, moderate), rhythm (skipping, bound, intermittent), depth (floating, sinking, hidden), length (long, short) and width (fine). So far this is fairly standard. However, the primary strength and originality of the book lies in the way it goes on to define certain pulses according to the state of the radial artery in biomedical terms. For example certain pulses are defined by their arterial wall tension and the ease with which the arterial wall can be occluded (wiry, tight, scallion, drumskin and scattered). This contextualisation of the pulse in terms of contemporary biomedicine is illuminating and useful.
The book then returns to traditional definitions by defining the remaining pulses in terms of force (replete, firm, vacuous, faint, weak and soggy) and contour (slippery, rough, surging, stirred), and in all of these, arterial wall tension, ease of occlusion of the radial artery or volume of blood flow in the artery are presented as important parameters to be considered.
Having described each pulse in detail and given a clear explanation of what that pulse might indicate in terms of diagnosis (often with references to the Classics), the penultimate chapter of the book summarises the various pulses found in patterns such as heat, cold, dampness, stagnation or stasis. This cross referencing is also very useful. Then to finish, different systems of pulse diagnosis, such as five phase pulse diagnosis or the nine continent pulse system (taking the pulse at locations on the body other than the radial artery) are briefly mentioned.
In the early chapters of this book, there is some discussion of the contextual nature of pulse interpretation. For example the way the pulse may change with the seasons, or pulse variations according to gender, age, pregnancy or body type. However, this is a book that primarily concentrates on the twenty eight individual pulse pictures and their interpretation as discrete entities.
This is a very useful starting point for pulse diagnosis and is to be welcomed. However, the more I work with pulses, the more I recognise that very often we are dealing with a sliding scale or continuum between pulse qualities. For example, a pulse may be wiry, or it may be somewhere on the continuum between wiry and fine, or even between wiry and slippery. The way we name that pulse may depend on the context in which we feel it. I remember a strong young man in one of my classes who had a long slippery pulse. Under the pressure of having his pulse talked about to the class, he developed a classic wiry pulse. In this case, I would suggest the pulse may originally have been on the wiry side of slippery, firstly because of its length, and secondly because of the ease with which it became wiry. This wiry variety of slippery is both distinctly palpable and clinically useful.
It is easy to complicate pulse diagnosis, and it is usually a useful discipline to encourage students to commit to a specific pulse quality when they take the pulse. It is impossible to run before you can walk, and a clear starting point for pulse diagnosis such as is given in Pulse Diagnosis: A Clinical Guide is essential. But I have come to feel that even in the beginning it is useful to acknowledge there are many shades and nuances in pulse diagnosis. It is a wonderful tool for honing our sensitivity to our patients, and I would welcome further discussion of these nuances in pulse literature to come.
Frances Turner MPhil MBAcC MRCHM