Pulse Diagnosis and Tonification in Japanese Acupuncture
By Ted Hall
Japanese acupuncture is a vast category of Oriental medicine that includes a great many styles and traditions. In my study and practice, traditional Japanese acupuncture refers to an older style that is relatively simple in theory and principle.
This form is a five-element, meridian-based approach to acupuncture. Like many other forms of meridian therapy, pulse reading is the main diagnostic technique in this system. Pulse reading is given the most weight in assembling the treatment plan, even more than questioning diagnosis. Treatments are organized around relatively simple five-element patterns, with points needled on meridians related to findings in the pulses, in an effort to bring about a balanced usage of energy in the body.
The viewpoint that the body is an energetic field with a physical manifestation is one of the basic tenets of Oriental medicine. The body is not an object or a noun, but rather a verb, viewed as a multitude of processes, all interrelated. In formulating a diagnosis in Oriental medicine, we are not as concerned with the body's manifestations as much as with how the body is doing what it is doing. Qi precedes form. The symptoms that patients bring to the practitioner are manifestations of underlying energetic patterns. These patterns are what acupuncture influences. By altering these patterns, the acupuncturist is in effect offering a suggestion to the patient as to how his or her body can utilize its energy in a way that won't produce symptoms. In this system of traditional Japanese acupuncture, pulse reading provides a direct view into the underlying energetic patterns behind the symptomological manifestations.
Pulse reading in traditional Japanese acupuncture provides the greatest amount of diagnostic information, which is not necessarily the case with pulse reading in other forms of Oriental medicine. While there are many variations in the pulse reading techniques used in Oriental medicine, there exists some commonality in the basic elements that most practitioners consider. Excess and deficiency, at least as basic tendencies, are one such common thread. In my practice, excess and deficiency comprise the main focus of the pulse diagnosis process. Each of the 12 main meridians in the body is evaluated in the pulses for their relative deficiency or excess. On the one hand, this is a simplification of the information available in the pulses; on the other hand, it is an exceedingly specific tool for viewing the body's energetic process. It provides a look into exactly which aspects of the body's qi are doing what, and gives very specific information about how to respond to those imbalances in treatment.
Pulse diagnosis is furthermore very useful in monitoring the body's response to treatment. I typically read pulses several times throughout a course of treatment to check dosage levels and to watch how the body is responding to the treatment intervention (sort of like tasting a soup while cooking it to make sure it comes out right). I would suggest that an excellent way to study numerous aspects of our medicine is to read pulses not only at the beginning of a treatment, but also at the end. This provides us a very close connection with the cause-and-effect aspects of our treatment procedure, as well as with our patients' ability to respond to treatment suggestions.
Just as the pulses are evaluated for excesses and deficiency, every condition we diagnose and treat is seen as involving both excess and deficiency. In considering excess and deficiency, it is important not to look at the normal English meanings of these words. In Oriental medicine, they are not so much quantitative terms (as in the body having too much or too little energy), rather they are qualitative terms. If we look at the body as an event or a verb rather than a noun, excess and deficiency are more like adverbs telling us how the body is doing what it's doing (i.e., doing some things deficiently and some things excessively). Deficiency may be looked at in simple terms as an aspect of the body that is unable to perform its functions adequately due to a lack of effort or ability. Similarly, excess may be looked at as an aspect of the body that is unable to do its job adequately because it is trying too hard, or over-applying itself.
Just as yin and yang are applicable perspectives to any situation, excess and deficiency similarly coexist in every condition. Underperformance is often compensated for by overperformance. It then follows that every treatment involves both tonification and dispersion: tonification for the deficiency, dispersion for the excess. This logic will bring about a relative balance to how the body is using its qi, and how the body is therefore manifesting its physical form. By thus responding to and correcting the excess and deficiency we find in the pulses, we can positively influence the body's ability to take care of itself.
One of the most unique aspects of this particular system of traditional Japanese acupuncture is the emphasis on tonification. Tonification is the acupuncturist's response to deficiency, which is a significant part of most conditions. This is visible not only in pulse diagnosis, but also in the knowledge that deficiency and excess tend to coexist as yin and yang aspects of the same situation. For example, what difference is there between hope and doubt? One is excess; the other is deficient. Hope or desire (excess) is prevalent relative to what we subconsciously doubt we will get (deficiency). It seems logical that a major reason people act aggressively is to compensate for a relative lack of confidence, exemplifying excess as a response to deficiency. I don't know a single person who does not have some degree of inner fear or doubt. Despite our wonderful achievements, we are all afraid on some level that we won't be good enough. This is representative of the inner deficiency that is an underlying part of nearly every condition. This inner emptiness is what allows excess patterns to arise.
Excess tends to be obvious; its symptoms are loud and annoying, and they get our attention easily. Deficiency, on the other hand is quiescent and subtle, and is significantly obvious only when extreme. Excess conditions are commonly addressed because they demand attention. Deficiency is more easily bypassed, and can be left to continue as a pathological influence on the body's energetic process. It is for this reason (which is also readily apparent in the pulses) that tonification is the initial response to most conditions. It provides basic, crucial, underlying support for the body's own process of health, which is just what we want to encourage in providing holistic medicine. Such treatment is therefore an encouragement to the patient, supporting the deficiencies that subtly lie within imbalanced energetic patterns. Excess can then be easily and effectively responded to once the basic support of tonification is in place.
Pulse reading in traditional Japanese acupuncture, then, provides the practitioner with a direct view into the energetic patterns that produce physical form by focusing on excess and deficiency. From this perspective, treatment can respond with tonification and dispersion techniques. Tonification is emphasized initially because most excess symptoms come about as compensation for deficiency. Monitoring the pulses throughout the treatment provides the practitioner with a detailed view of how the patient is responding to the treatment process, and allows the dosage to be altered accordingly. The treatment therapy offered by this form of traditional Japanese acupuncture - tonifying underlying deficiency as a basis for dispersing excess, and using pulse diagnosis to monitor the process - specifically reminds the body of an easily assimilable energetic balance. This underlying energetic balance in turn allows the patient to manifest a relatively balanced physical form. In this way, the practitioner is able to empower the patient to take responsibility for his or her own health and happiness.