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Pulse analysis in Tibetan medicine.

Introduction

Disease is identified by its signs and symptoms. The relationship between these two is like that of fire and smoke. As symptoms are the pathogenetic results of disease and the best means of identification, thorough knowledge of the characteristics of a disease is absolutely essential in being able to diagnose it accurately.

The theory of diagnosis, therefore, involves symptomology and pathology, and an ability, acquired through theoretical study and practical experience, to relate one to the other.

Diagnostic application consists of two sections:

1) The three examinations

2) The three methods of diagnosis

The three examinations are

a) Etiological examination

b) Pathogenetic examination

c) Interrogative examination

The three methods of diagnosis are

a) Questioning

b) Examination by seeing

c) Examination by touching

The three examinations are really an extension of the first of the three methods of diagnosis, but have been treated separately because of their diagnostic importance

The diagnostic importance of the three examinations cannot be over emphasised. By etiological examination. i.e. finding out the causes and factors responsible for the disorder by questioning and examining the patient, the key to recognising the pathology of the disorder is made possible. Knowledge of the pathogenetic history enables the physician to further confirm the nature of the disease. By interrogating the patient as to his reaction to particular diet and behavioural patterns, the physician is able to plan out the course of treatment to be prescribed.

Examination by touch

Pulse reading is an art in itself, requiring extensive theoretical study followed by years of familiarity with the areas of the pulse.

Basically pulse reading involves the ability and skill of the physician in being able to pick up the impulse transmitted to the arteries, particularly the radial artery, and translate the message in term of etiological and pathological factors. Impulses from various major solid and hollow organs are transmitted by the blood and wind flow to the arteries, and most clearly to the radial artery. The radial artery acts as a messanger between the doctor and patient. However, the ability to translate the messages picked up by the finger tips of the physician will largely depend on the experience and knowledge the physician has acquired.

Preliminaries

Generally, pulse palpatation is greatly affected by any action which one does not usually engage in. For instance, diet and behaviour patterns visibly affect the pulse beats. Therefore, it is most important that the patient's pulse beat is not affected by any action which is not related to the disorder. In order to ensure this, the patient and also the physician is required to observe certain regimens for at least the day before the pulse is read.

-- abstinence from overly nutritious food such as wine, meat and so forth

-- abstinence from eating raw, stale food

-- from thick tea

-- from very cold food such as mutton

-- refraining from excessive exposure to heat or cold

-- from strenous activities or laziness

-- from excess coitus

-- from sleeplessness

-- from overeating or going hungry

In short, the patient and physician should not take any food and engage in any actions which would affect the state of the body.

The time to read the pulse

The ideal time to read the pulse is at dawn when the respiratory cycle is at equilibrium. However, if the pulse is read at any other time, the possibility of misreading is great. If the pulse is read before dawn, the predominance of cold elements could be easily mistaken for cold disorder. Similarly if the pulse is read after dawn, the predominance of hot elements in the body and environment make it easy to mistake this for a heat disorder. However, in cases of emergencies, the minimum requirement is to ensure that the physician and the patient are breathing normally. It is also important to observe that the patient is not stiff, sweating from exertion, and that his hands are not constricted in any way.

Anatomy for reading the pulse:

The pulse is read at the radial artery at each wrist. From the first crease of the flex or surface of the distal forearm at the wrist, use one tsun measurement proximal to this crease on the tsun of the radial artery. One tsun is a unit of measurement equivalent to the length of the second phalanx of the thumb. The three fingers, namely, the ring, middle and index, are placed, parallel and straight, evenly spaced with approximately a grain of rice space in between each finger so that the fingers are neither touching each other nor are they too far apart.

The reason why the radial artery is used as the place of pulse taking is because though there are many accessible arteries all over the body such as the carotid femoral and posterior tibial artery pulses, the radial artery is centrally located in the body, being neither too far nor too close from the major solid and hollow organs. Other pulses, such as those mentioned, either have an abnormally high concentration of blood and wind because they are very near the heart and liver, or have an abnormally low concentration of blood and wind because they are too far away from the heart. So, though disorders may be generalised by reading these pulses, it will be very difficult to localise and identify specific disorders.

Blood and wind from all major organs of the body flow through the distal radial artery transmitting messages as to the condition of each of the organs. These are picked up by the trained finger tips of the physician at various points of the patient's wrist. Just as the waves of the ocean affect the flow of the ocean, similarly the wind or energy, which flows along with the blood, affects the blood flow depending on the balance or imbalance of the three humours which constitute the body. Consequently, the radial artery will have an empty, tight, declining, rolling and so forth, pulse beat.

The life base pulse or the pulse which determines one's life span should be read on the ulnar artery. The death pulse should be read on the posterior tibial artery as Tibetan medical philosophy asserts that when the death cycle takes place, dissolution or disintegration of the energies of the body begin from the lower part of the body.

Pressure to be applied in reading the pulse

Generally, the pressure applied on the wrist is classified as follows:

a) the index finger pressurised enough to feel the skin

b) the middle finger pressurised to be able to feel the flesh

c) the ring finger pressurised most to feel the bone

The reason for applying varying pressure on various points of the wrist is because the radial artery grows from the flesh in the wrist just as a radish grows out of the ground, and consequently, the radial artery tends to get embedded deeper as it moves further away from the wrist crease.

Method of taking pulse

In pulse taking, the physician's finger must be smooth, sensitive, without scars and pliable. The left wrist of a male patient is read first while the right wrist of a female is read first. For male patients, the physician's right hand is divided into sections as follows:
Index    upper division   lower division
         heart            small intestines
Middle   spleen           stomach
Ring     left kidney      reproductive organs


The left hand is divided into the following sections:
Index    upper division   lower division
         lung             large intestines
Middle   liver            gall bladder
Ring     right kidney      urinary bladder


The organic representation in the case of a female is exactly the same as in the case of a male, except that the lung and heart positions are interchanged. The reason for the switch is because the position of the invisible apex of entrance of the life force is slightly different in the sexes.

The constitutional pulses

Even in a healthy organism, pulse beats vary. This is because the temperamental and constitutional composition of each individual is different. In the normal course of conception, non-pathogenic predominance of any of the three humours takes place due to any of the following reasons:

a) karma

b) dominance of a particular temperament

c) mother's intake of types of food and her behaviour patterns

Basically, there are three types of constitutional pulses:

a) male

b) female

c) neuter

A male constitutional pulse the pulse of a person with a predominance of wind; consequently, his pulse beat is rough and thick. A female pulse is that a person with a predominance of bile, and therefore has a rapid and thin beat. A neuter pulse beat is generally found in a phlegm-predominating person and the pulse beat is smooth and pliable.

The constitutional pulses are not based on sex-a male may have a female constitutional pulse and so forth. If a male has a female constitutional pulse, this signifies a long lifespan, a female with a male pulse means birth of sons and daughters who will later be respectable individuals. If a couple has male and female pulse respectively, though they will have a long lifespan, their aunts and uncles will be antagonistic towards them. If both the couple has female pulses they will have more daughters than sons and if the couple has male pulses they will have more sons.

The four seasonal pulse reading

With the change in seasons, the pulse rythm changes accordingly. It is, therefore, of utmost importance to keep the seasonal rythm patterns in mind, and have experience and knowledge to relate them to the physical organs and the external energies. Astro-medical seasons are of five types, each made up of 72 days. The fifth season is composed of four transition periods, each of 18 days which are interspersed among the four other seasons. As standardisation of calenders and chronometers was not a part of Tibetan technology, the medical texts give descriptions of various signs and events during each season so that the physician may discern the proper season and choose his treatment accordingly.

During the 72 days of spring, the general pulse corresponds to the beat of the wood liver pulse which is thin and tight. During the 18 days of the transitional season, the general pulse has the beat of the earth spleen pulse, i.e. a short and smooth beat. During summer season the general pulse has a fire heart pulse beat i.e. thick and long. During autumn the pulse has a iron lung beat, i.e., a short and coarse, and during winter the general pulse will beat like the kidney/water pulse, i.e. smooth and slow.

The change in the beat of the general pulse during each season is not pathogenetic and therefore, without a knowledge of the seasonal pulse, gross errors in diagnosis could be committed.

Healthy pulse beats

Generally, the best method of determining a healthy from an unhealthy pulse is to measure whether the pulse beats five times during one respiratory cycle or 75 times regularly in a minute. The beats must not be strong, slow, deep, superficial, empty, rapid and so forth. If during one respiratory cycle the pulse beats are more than five, it signifies a hot disorder, and if less than five, cold disorder.

Basically, the pulse in health and disease can be determined by the rate, nature and volume of the pulse. The preliminary requirement is that the physician should know the constitutional pulse of diseases to which the patient is prone and the medical history. A thick, bulky or floating pulse is compatible with a male constitutional pulse, but should be confused with a hot disorder. A quick and thin pulse is characteristic of a female constitutional pulse, but could be confused with hot bile. A continual, smooth pulse is characteristic of the neuter pulse, but could easily be confused with a phlegm pulse which is usually deep and slow. Also, if the constitutional pulse stops suddenly after beating regularly or if pulses were missed irregularly, this could easily be confused with the death pulse.

Disorder pulses

In order to utilise pulse reading as a means of diagnosis, the first step which serves as a foundation, is to be able to distinguish hot and cold pulses. On this depends the ability to identify specific disorders.

The six hot pulses

The six hot pulses are: strong, superficial, rolling, rapid, taut, and hard. Generally, strong and superficial pulses are evident on the surface and signify fresh hot disorders. Rapid pulses such as the rolling and rapid pulses signify fresh disturbed fever. Deep pulses such as taut and hard signify old fevers.

The six cold pulses

The six cold pulses are: weak, deep, declining, slow, loose, and hollow. Deep pulses like the first two denote fresh cold disorders while slow and hollow pulses with few beats signify old cold disorders.

Specific disorder pulses

Pulses of single disorders
Wind:    superficially high, and hollow when pressurised
Bile:    thin and taut
Phlegm:  deep and declining


Pulses of Double combined disorders:
Wind and fever:    by nature empty or hollow, with a rapid beat
Phlegmic bile:     superficially deep, and taut beneath
Phlegmic wind:     by nature hollow, with slow beats


Specific disorder pulses:
triple combined
abdominal disorder:   thick and filled, and the abdominal pulse
                      is unclear
Blood disorders:      protuding and rolling though the beats
                      are slightly slower than a pregnancy pulse
Lymphatic disorder:   quivering and difficult pulsation
leprosy:              unclear, limping and quivering


Pulse of disorders in terms of their locality

In order to determine the location of disorders by means of pulse reading, one must thoroughly know the respective pulse in relation to every part of the body. By reading the pulses under the index fingers, the physician should be able to localise and identify disorders of the upper extermity, while the thorax-abdomen disorders are identified by reading the middle finger's representations. The ring finger identifies disorders of the lower extermities. More specifically, the upper finger divisions of every finger on both hands help to identify disorders of the 5 solid organs, while the lower divisions identify disorders of the 6. hollow organs.

Death Pulse

The death pulse is of three types: changing, irregular, and associated with wind disorders, the pulse is found to flutter like a flag in the wind. The stopping type of pulse is associated with phlegm disorders and is like the dripping of water.

The presence of certain physical signs concurrent with a pulse findings can indicate impending death. For instance, if the heart of small intestine pulse is absent and the tongue is found to be black with the eyes in a fixed stare, death occurs in a day. The irregular or stopping pulses are also associated with evil forces.

Life span pulse

Life is uncertain, and the attainment of a human birth is due to one's past actions. The place of life is called the life base which is physical in nature.

The life span pulse is taken on the ulnar artery of the patient. If the life pulse beats normally, life span will be normal. If the ulnar pulse is unstable the life base is unstable, and if the pulse is nearly absent life will end although the means of ascertaining the exact time of death may be difficult.

The pulse is essentially the key of identifying disorders. It reveals most of the nature and constitution of an individual in terms of his pathogenic and nonpathogenic characteristics.

Prognostication

Apart from diagnostic utility, pulse reading is used for prognosis. The theory of prognosis is based upon the philosophy that a sensitive relationship exists between individuals and their environment which determine, and influences the individual temperament and constitution.

Prognostication is mainly based on the theory of engenduring and control which in Tibetan is called the mother-son and enemy-friend cycle. This law is a cyclical interrelationship of each element such mother of wood is water, the mother of fire is wood and so forth. Similarly, fire is the son of iron, earth is the son of fire and so forth. In this instance, mother may be taken in a metaphorical sense to mean that which activcally passes on nuturing energy, while son may be thought of as that which is receptive to nuturing energy.

Tibetan medical system is one of complimentary opposities. As there is a cycle of nutriment and engenduring in the mother-son cycle of the elemental energy, so there is a system of checks and balances or a controlling cycle which is called the enemy-friend cycle. In this cycle, water is the enemy of fire, earth is the enemy of water and so forth. Similarly, wood is the friend of iron, earth of wood and so forth.

On the physical or material level each element is manifest in different body parts. In particular, there is a strong association between vital organs and each element. The five elements pervade every aspect of life experience. Hence they are intimately related with time and the seasonal calendar.

If the seasonal pulse and the mother pulse (heart and liver during summer; liver, being the mother of heart) are similiar, this signifies that the best of everything will be showered upon the person.

If the seasonal pulse and the friend pulse (heart and lung during summer) are similar, this signifies that the person will be wealthy. If the seasonal pulse and the foe pulse (heart and kidney during summer) are similar, this signifies either that the person will meet an enemy or that he will fall sick; with an incurable disease and death is almost certain. Pulse reading is the core of Tibetan diagnostic methods and is relied upon most by the physician in his attempt to identify diseases. It is an efficacious and accurate method requiring years of experience before it can be practised effectively.
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Article Details
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Author:Rabgay, Lobsang
Publication:The Tibet Journal
Article Type:Essay
Geographic Code:9CHIN
Date:Mar 22, 2012
Words:2936
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