Ensayo Sobre Ley Ada

Journal of Chinese Medicine • Number 89 • February 2009

Pulse Diagnosis: An Introductory Guide for the Experienced Practitioner

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Pulse Diagnosis: An Introductory Guide for the Experienced Practitioner
Abstract
Pulse diagnosis is widely regarded as a core component of the diagnostic framework of Chinese medicine. Such regard for pulse diagnosis is founded on the premise that pulseassessment is a clinically reliable diagnostic method. The validity of the pulse as a diagnostic tool tends to be founded on its historical roots in antiquity; because pulse diagnosis has been in use for so long, its validity is rarely questioned. Such uncritical acceptance of the information provided by classical texts (and reiterated in contemporary literature) has left the pedagogical framework forthe use of pulse diagnosis compromised, and subsequently its reliability as a diagnostic tool is questionable. In many cases, the information available for practitioners is either ambiguous, lacking clear instruction on the use of pulse diagnosis, or contradictory, with different authors holding opposing views. This paper aims to clarify some of the problems associated with the use of pulsediagnosis in a modern context, and to encourage practitioners to identify misconceptions regarding pulse diagnosis, thus facilitating its use as a reliable diagnostic tool in contemporary clinical practice. By: Sean Walsh, Emma King and Greg Simpson Keywords: Pulse diagnosis, Chinese medicine, reliability, validity, inter‑rater agreement, pulse quality, normal pulse.

Introduction
he contemporarypractice of pulse diagnosis is arguably more complicated than in the past. This is not because it has become more difficult to learn or to practise; nor is the pulse diagnosis used today fundamentally any different from that used in the past; rather it is because of the comparatively greater number of sources of information available to the modern practitioner of Chinese medicine. The contemporarypractitioner has access to information from many different branches of Oriental medicine. This diversity of approaches, and the associated extensive canon of literature, combine with a huge body of knowledge from modern biomedicine. In many cases, the information available to the modern practitioner remains ambiguous, lacking in clear instruction regarding pulse diagnosis. Where there is noambiguity there is frequently conflict, with different authors holding opposing views, even when describing the same pulse quality. This paper clarifies some of the difficulties associated with the practice of pulse diagnosis, and places them in the context of contemporary clinical practice. Practitioners may question the necessity and value of such an investigation, arguing that the antiquity of thepulse within the diagnostic framework and canon of Chinese medical literature is evidence enough of its clinical validity. Such arguments are, however, based on the premise that pulse assessment is a

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clinically reliable technique. Unfortunately there is no significant body of evidence to support this assertion. In the experience of the authors, it is the resolution of such difficultiesinherent in pulse diagnosis that ultimately determines its correct use and application. By developing awareness of the problems associated with such a large, critically unchallenged body of information, it can make a difference as fundamental to the contemporary practitioner as the ability to discriminate a pulse indicating health from that indicating illness. This paper aims to encourage practitionersto initiate the challenging process of identifying misconceptions regarding pulse diagnosis and its use in Oriental medicine (irrespective of style), through the critical examination of the available literature. It is important that the modern practitioner is able to discriminate between fact and fantasy in the literature, and understands the importance of critically appraising the claims made...