The flow of qi is one of the basic constituents of the human body and its functions; our body's ability to make quality qi is essential to good health. We know that qi is the product of the activities of, and communication between, the zang and fu organs.Therefore, it makes sense that having the ability to examine that flow in the pulses would be key to making an accurate diagnosis.
Examination of the pulses (pulse diagnosis) is a complex art and remains mysterious to some practitioners. For those who have acquired the skill, however, it is possible to accurately read imbalances in the flow of qi in the pulses and give a diagnosis or identification of the root of those imbalances. Further, it is possible to distinguish historical imbalances from current ones. Students and graduates still frequently report their inability to feel the flow of qi in the pulses and interpret what they are feeling. They say that they hear too many different, even conflicting, opinions from their instructors about the meanings of what they are feeling. This is a real shame, in my opinion, because making a correct diagnosis is the most important part of creating an effective treatment plan.
A successful treatment plan cannot simply consist of treating the patient with the same acupuncture or herbal prescription over and over. Needling UB 13, 15, 17 and 43, SI 3, K7 and H6 at each visit for night sweats, just because it's a prescription, is not a very effective way to treat a patient. If your treatment plan is working, the patient's energetic state should be changing from treatment to treatment. Why would you continue to use the same "prescription for night sweats"? Regardless of the chief complaint, it is our professional responsibility to make the diagnosis and monitor energetic changes as treatment continues.
Unfortunately, much of our training teaches us to reduce a complex health condition down to a standard pattern. This can lead to misdiagnosis and inappropriate treatment. Why? Because it is unrealistic to think that a catastrophic health condition can be reduced to one pattern or even some set of patterns. To then treat such a complex condition with a standard treatment protocol or set of points ignores the uniqueness of each person and the unique factors that have led to their condition. One must be able to identify the relationships among the organ systems for a comprehensive diagnosis and development of a treatment plan. Hearing about symptoms and their modern medical diagnosis is not enough information to guide a treatment plan and may mislead you. Our "promise" is to find the root of the problem, treat that root and change the state of the patient's health. We find the root using pulse diagnosis.
This idea of looking at the flow of qi through the organ systems in the pulses is nothing new. Li Shi Zhen talks about pulse movements in addition to feeling pulse qualities. Our basic training teaches us that yin and yang create each other. They balance each other, they are components of each other, and their relationship is dynamic and ever-changing. This can also be a description of the pulses as yin and yang energies flow from organ to organ, communicating and connecting (or not, in which case there are imbalances in the system that are causing symptoms or conditions). Our bodies are in a constant state of flux, which should be apparent when we feel the pulses. When we insert acupuncture needles into the body, they should create a palpable change in that flow toward balance. Frequent examination (or re-examination) of the pulses during treatment is the only way to be certain that your treatment plan is working. If you can't feel the pulses moving toward a balanced state, then your plan is not working.
The sine wave, the central part of the tai chi diagram, is the quintessential symbol for the continuous and ever-changing flow of qi. This sine wave is the basic component of what we should feel in the pulses when all systems are communicating with one another and in harmony. The yang part of the wave rises to a rounded peak before it descends into the yin portion which then rises again to become yang. The movement is smooth and continuous in the balanced, normal pulse. Any movement away from this sine wave is indicative of imbalances in the system, or imperfect health.
As one studies the pulses in more depth, specific patterns of movement can be seen for a number of chronic conditions including depression, unresolved emotional issues, insomnia, etc. These signature patterns, as I call them, are a combination of movement and the location of the movement. In other words, where is the movement located? Is it coming from the liver toward the heart? Is the spleen movement unable to support the lung position? At what depth are you feeling the movements? The answers to these questions will give you a coherent view of the patient's condition, including the historical bases for it.
Finally, if our medicine is to be accepted in the Western world, we must be able to explain diagnoses in a manner that makes sense to our patients. Telling a patient they have damp heat in the lower jiao makes absolutely no sense to them. If you can explain that their worrying is making their qi (as seen in their pulses) move in an out-of-balance manner, then you have given them information with which they can work. You have told them that their lifestyle, way of thinking and emotional state are creating energetic imbalances that can negatively affect their health. You are an assistant, a guide if you will, for helping them make changes in their life that will affect the flow of qi in their body.
A basic premise behind TCM is that a regulated, normal flow of qi creates good health. Other principles include the fact that we can have some control over the state of our qi through meditation and lifestyle. In addition, the prevention of disease is possible when we maintain balance. If we can assist our patients in understanding how qi should be flowing and which activities, foods, medications etc., alter that flow in a negative way, then we have given them a great opportunity to regulate their own system.
Does anyone have this normal, balanced pulse? No. We all have lives and stressors. For example, we are aging. However, when you use a method of pulse diagnosis that feels the flow of qi and you can explain it, or even show your patients of a picture of it, then you have the opportunity to create a true partnership between yourself and the patient. You have the ability to demonstrate to them how TCM works, how yin and yang flow to balance each other, how they can change that flow for the better. Focusing exclusively on the quality (slippery, wiry, thin, etc.) without recourse to the movement can lead to misdiagnosis and prevents you from feeling the more subtle activity that is inherent in the pulses. This is the very activity that can give you a comprehensive picture of your patients' current and historical health and emotional history.
Click here for previous articles by Martha Lucas, PhD, LAc.