Pulse Diagnosis

Page 1 of 11

Cute little bird

Traditional Chinese Medicine and Pulse Diagnosis In San Francisco Health Planning: Implications For a Pacific Rim City
By Richard Kass

Dissertation, Social Welfare Department University of California, Berkeley Copyright, (c) April 1990 By Richard Kass Questions, comments, or requests may be addressed to: Michael Broffman, L.Ac. or Michael McCulloch, L.Ac. at chinamed@well.com Pine Street Chinese Benevolent Association 124 Pine Street San Anselmo, CA 94960

Abstract
The purpose of this dissertation was twofold: 1) to provide background material on the Asian American culture and dual health care system in San Francisco; 2) to examine how Traditional Chinese pulse diagnosis (a renowned ancient diagnostic technique) can be used to help integrate the dual health care system in San Francisco. The overarching vision for the project is a culturally responsive health care system in San Francisco which effectively controls the spread of chronic disease. Data collection was carried out at On Lok Senior Health Services in San Francisco. Ten subjects were examined by two Traditional Chinese physicians; one using a Traditional hand palpation method and the other using a computer assisted pulse detection device. The physicians examined the pulse of the same 10 subjects and attempted to: 1) obtain the same pulse readings on a given subject (a test of the reliability of pulse diagnosis); 2) match subjects with their corresponding medical files on the basis of pulse analysis alone (a test of the validity of pulse diagnosis). Three precautions against experimenter bias were observed: 1) the subjects sat behind a screen with only the diagnostically relevant area of their wrists visible to the two physicians (a special glove was worn); 2) no contact was allowed between the two examining physicians at any time during the study; 3) the pulse examination schedule was altered in the middle of the day in order to avoid any detectable patterns. In the general and individual pulse assessment sections the physicians achieved a significant p<.0001 reliability finding. 463 matches out of a possible 660 matches (70%) were achieved in the individual pulse section (p< .0001 for 463 or more matches). Other findings suggested that there may be some validity to Traditional Chinese pulse diagnosis; one of the physicians was able to achieve a significant result (p<.047) for six correct subject/medical file matches when 1st, 2nd, & 3rd choices were taken into account. However, this conclusion must be tempered in light of a serious methodological problem which may have influenced the results.

Acknowledgments

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 2 of 11

The kind cooperation of John Shen, On Lok Senior Health Services staff and clients, Dr. Michael Broffman, L.Ac., and Dr. Michael McCulloch, L.Ac. is greatly appreciated.

Table of Contents:
Traditional Chinese Pulse Diagnosis: Introduction & Review of the Current Literature Investigation of Traditional Chinese Pulse Diagnosis Subjects Materials and Equipment General Pulse Section Sub Pulse Type Section Individual Pulse Section Procedure Data Analysis Reliability of Pulse Diagnosis Validity of Pulse Diagnosis Discussion Introduction Significant Results Conclusion

Traditional Chinese Pulse Diagnosis: Introduction & Review of the Current Literature
Traditional Chinese physicians use palpation to differentiate 31 pulse patterns at 18 positions on the right and left wrists. This delicate technique reportedly provides: 1. A genuine early diagnosis of functional disorders which, if left untreated, eventually will produce degenerative or malignant organic changes; 2. The specific and comprehensive, all-inclusive determination of all factors having a bearing on complex pathological processes (at the roots of chronic or constitutional diseases); 3. Specific and comprehensive and direct appreciation of the immediate effects of any applied drug or therapeutic measure or agent (indispensable for the immediate follow-up of any therapeutic measure, as well as in the assaying of new drugs). (Porkert, 1983). Traditional Chinese pulse diagnosis is the single most important technique in Traditional Chinese medical diagnosis (Broffman & McCulloch, 1986). One problem with Traditional Chinese pulse diagnosis in the United Sates is that it tends to be unreliable; rarely will two physicians come up with identical pulse assessments for a given patient. This circumstance has: 1) discouraged physicians from performing comprehensive pulse examinations on their patients jeopardizing treatment success); 2) increased skepticism toward Traditional Chinese medicine (pulse diagnosis and other aspects of Traditional Chinese medicine are suspected of being invalid); 3) been a barrier to the scholarly investigation of Traditional Chinese medicine (clinical trials which are not based on accurate and comprehensive pulse diagnoses are inconclusive).

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 3 of 11

Advocates of Traditional pulse diagnosis contend that the problem lies in the application of the technique and not with the technique itself. They argue that: 1) pulse diagnosis is extremely difficult to learn (few physicians have the tactile acuity to detect subtle variations at three levels of palpation pressure); 2) few physicians are willing to devote the necessary time to master the technique (5-10 years of supervision is often needed). Several electronic devices have been developed which reportedly achieve more accurate measurements of energy at acupuncture points and meridians as well as make such technology more accessible to physicians (Laub, 1983; Lee, & Wei, 1983; Broffman & McCulloch, 1986; Tiller, 1982). These devices and their associated techniques have not become an accepted part of conventional medicine for three major reasons: l) the techniques are often unreliable (Kenyon, 1984); 2) no body of scholarly research exists demonstrating their effectiveness; 3) the metaphysical theory upon which these devices are based is untenable to most Western health professionals. Although several recent studies have supported the efficacy of this technology (Tsuei, Lehman, Lam, & Zhu, 1984; Sullivan, Eggleston, Martinoff, & Kroening, 1984), none have appeared in major medical journals. An evaluation of both traditional and electronic pulse-taking techniques was undertaken in this dissertation research. The aim was to: 1) assess the validity of Traditional Chinese pulse diagnosis; 2) determine if electronic devices can be used to increase the accessibility (with respect to requisite training) of this diagnostic method; 3) assess whether Traditional Chinese pulse diagnosis can be used to help integrate the dual health care system in San Francisco. Significant positive results would place Traditional Chinese medicine on a stronger scientific footing and suggest a greater role for Traditional Chinese medicine in the orthodox medical system in San Francisco.

Investigation of Traditional Chinese Pulse Diagnosis

Subjects
Ten subjects from On Lok Senior Health Services in San Francisco participated in this study of Traditional Chinese pulse diagnosis. These subjects were recruited on the basis of the contents of their medical file at this center; a medical file was considered appropriate for the study if it: 1) did not contain references to physical or physiological conditions at the pulse examination area that might constitute a confounding variable; 2) did refer to such conditions at the pulse examination, but these conditions could be controlled for. Of particular concern was any medical file reference (direct or indirect) to: pulse beat abnormalities, the consistency of the radial artery (e.g.; hypertension), the physical condition of the area surrounding the wrist area (e.g.; an overweight individual has fatter wrists), abnormal shaking at the wrist area (e.g.; some manifestations of Parkinson's Disease), the sex of an individual (e.g.; women generally have smaller wrist bones). The aim was to eliminate or obscure unfair clues that could positively influence the physicians' attempt to correctly match anonymous medical files with subjects on the basis of pulse analysis alone. The following selection criteria were ultimately used to select the subjects: all subjects were female; 1. age and weight differences between subjects were minimized (the mean age was 80.5 years old); 2. no subject suffered from skin problems at the wrist area; 3. all subjects had a history of hypertension; 4. all subjects were free of pulse beat abnormalities,

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 4 of 11

5. all subjects were free of shaking syndromes at the wrist area; 6. each subject suffered from a unique set of disease conditions (so as to enable the physicians to distinguish one subject from another); 7. all subjects were Asian Americans.

Materials and Equipment

Medical files at On Lok Senior Health Services in San Francisco (see Appendix E) contain comprehensive medical information on every client who visits the center. These files are updated regularly (usually on a daily basis) and are considered an accurate and comprehensive account of what disease conditions plague On Lok clients at any given time. The files were used in this investigation to verify the health condition of each subject at the time of his/her pulse examination. The following bits of information were deleted from each file in order to avoid any confounding variables: name, age, height, weight, pulse rate, and blood pressure information. An electronic pulse-taking device developed by Dr. Laub (1983), working in conjunction with Dr. Broffman and Dr. McCulloch (1986) was used by one of the two Traditional Chinese. physicians taking part in the study. This device detects radial artery pulse signals at the same 18 positions palpated by Chinese physicians thousands of years ago. Pulse images are digitized by the device and written to disk as a computer file. Each image can then be printed out (see Appendix D), matched with one of the 31 recognized pulse patterns in Traditional Chinese medicine (Porkert, 1983), and used for diagnostic purposes. Pulse Assessment Form A (see appendix B) was used in the test of pulse diagnosis reliability. This form is divided into three main sections. General Pulse Section The first section (general pulse section) assesses the radial artery pulse as it appears at three spatial locations (inch, gate, and foot) and three depth locations (superficial, middle, and deep) in the left and right wrist area. This assessment is general in nature and does not separate out unique characteristics of the pulse at the various spatial and depth locations. A total of eleven pulse categories are considered in this section. Each category is associated with two qualitative dimensions: 1) depth: floating or deep (a floating pulse is found in the upper region of a pulse position while a deep pulse is found in the bottom region); 2) intensity: strong or weak (a strong pulse refers to a forceful beat while a weak pulse refers to a delicate beat); 3) amplitude: big or small (a big pulse refers to a large stroke while a small pulse refers to a short stroke); 4) frequency: fast or slow (a fast pulse refers to frequent beats while a slow pulse refers to infrequent beats); 5) rhythm: rhythmic or arrhythmic (a rhythmic pulse refers to uniform cycles of the pulse while an arrhythmic pulse refers to irregular cycles); 6) length: long or short (a long pulse has a wide base while a short pulse has a thin base); 7) type: yang or yin (a yang pulse is characterized by an expanded pulse while a yin pulse is characterized by a deflated pulse);

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 5 of 11

8) temperature: hot or cold (a hot pulse is associated with an energetic pulse rate while a cold pulse is associated with a lethargic pulse rate); 9) quantity: shih or cold (a shih pulse contains a large amount of energy while a cold pulse contains a small amount of energy); 10) texture: hard or soft (a hard pulse is characterized by a pointed top while a soft pulse is characterized by a round top); 11) width: wide or thin (a wide pulse has a large peak while a thin pulse has a narrow peak). Sub Pulse Type Section Section two (sub pulse section) provides for a more detailed analysis of four of the eleven pulse categories in section one (depth, intensity, amplitude, and frequency). Depending on what decisions were made in this prior section, each physician chooses from among the pertinent "Sub 1" and "Sub 2" qualitative dimensions described below: 1) For floating pulses: simple, flooding, or none (sub 1) and soft, bowstring hollow, leathery, or none (sub 2) 2) For deep pulses: simple, hidden, or none (sub 1) and weak, prison, or none (sub 2) 3) For either strong or weak pulses: full, feeble, thready, or none (sub 1) and slippery or none (sub 2) 4) For either big or small pulses: long, short, or none (sub 1) 5) For slow pulses: simple or none (sub 1) and knotted or none (sub 2) For fast pulses: simple or none (sub 1) and rapid, agitated, or none (sub 2) Individual Pulse Section The third section of Pulse Assessment Form A (individual pulse section) describes the pulse as it is found at each of the three spatial locations (inch, gate, and foot) at the left and right wrist area. The same eleven pulse categories are used to analyze these six spatial locations. The various depth location findings (superficial, middle, and deep) at each spatial location are taken into account in this assessment: 1) depth: floating or deep; 2) intensity: strong or weak; 3) amplitude: big or small; 4) frequency: fast or slow; 5) rhythm: rhythmic or arrhythmic; 6) length: long or short; 7) type: yang or yin; 8) temperature: hot or cold;

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 6 of 11

9) quantity: shih or cold; 10) texture: hard or soft; 11) width: wide or thin Assessment Form B (see Appendix C) was used in the assessment of pulse diagnosis validity. This form allowed each physician three opportunities (1st, 2nd, & 3rd choice) to correctly match a given medical file (coded A through J) with a given pulse (Coded 1 through 10). The level of certainty associated with each attempted match was indicated by the attachment of one of three symbols (* = confident, + = fairly sure, - = doubtful) to each proclaimed match.

Procedure
In August of 1988 data collection for the pulse analysis component of the study was completed at On Lok Senior Health Services in San Francisco. Ten subjects were examined by two Traditional Chinese physicians; one using the Traditional hand palpation method and the other using a computer assisted electronic device. The two Traditional Chinese physicians were selected on the basis of their extensive experience using this form of diagnosis and the fact that one of them (Dr. McCulloch) used an electronic method of pulse diagnosis (Broffman & McCulloch, 1986). The two physicians examined the pulse of the same 10 subjects and attempted to: 1) obtain the same pulse readings on a given subject (a test of the reliability of pulse diagnosis); 2) correctly match subjects with their corresponding medical files on the basis of pulse analysis alone (a test of the validity of pulse diagnosis). The two Traditional Chinese physicians administered their respective pulse examinations over the course of a single day in a specially prepared room at On Lok Senior Health Services. Three precautions against experimenter bias were observed: 1) the subjects sat behind a screen with only the diagnostically relevant area of their wrists visible to the two physicians (a special glove was worn) 2) no contact was allowed between the two examining physicians at any time during the study; 3) the pulse examination schedule was altered in the middle of the day in order to avoid any detectable patterns. All pulse examinations were timed by the research assistant. The matching of the ten medical files to the two sets of pulse profiles (one traditional set and one electronic set) occurred after all pulse examinations had been completed. The physicians were given as much time as needed to fill in the two assessment forms, and were allowed to consult any resource materials. The assessment process took each physician approximately two hours.

Data Analysis
Reliability of Pulse Diagnosis
The following hypotheses were constructed to test the extent of correlation (reliability) between Traditional pulse readings and electronic pulse readings: H(0) = matches between Traditional pulse readings and electronic pulse readings are the result of chance alone; there is no evidence to suggest that Traditional Chinese pulse-taking is reliable. H(1) = matches between Traditional pulse readings and electronic pulse readings are not the result of

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 7 of 11

chance alone; there is evidence to suggest that Traditional Chinese pulse-taking is reliable. An exact correspondence between how Dr. Broffman evaluated a given pulse category for a given subject and how Dr. McCulloch evaluated the same category was considered a match in all three sections of Assessment Form A. The normal approximation to the binomial (Parzen, 1960, p. 239) was employed to determine whether the results obtained (or more extreme results) were better than chance alone would normally produce. The probability of at least x matches is the sum of the binomial probabilities [x + (x + 1) + (x + 2) ...] which can be approximated by a normal distribution. A probability value of <.05 was considered significant. The percentage of correct matches in all three sections were calculated as an additional way to assess the reliability of the two methods of pulse analysis. The results for the three sections were as follows: 87 matches of a possible 110 matches, 24 (79% of possible matches) were achieved in the general pulse assessment section. The probability of this result or more extreme results occurring by chance alone is p< .0001. In the sub pulse section: 4 out of 5 possible matches (80% of possible matches) were achieved in the depth/sub 1 category (p=.023 for 4 or more matches); 1 out of 4 possible matches (25% of possible matches) were achieved in the depth/sub 2 category (p=.52 for 1 or more matches); 2 out of 7 possible matches (29% of possible matches) were achieved in the intensity/sub 1 category (p=.56 for two or more matches); 1 out of 2 possible matches (50% of possible matches) were achieved in the intensity/sub 2 category (p=.75 for one or more matches); 2 out of 7 possible matches (29% of possible matches) were achieved in the amplitude/sub 1 category (p=.74 for two or more matches), 7 out of 7 possible matches (100% of possible matches) were achieved in the frequency/sub 1 category (p=.0078), and 7 out of 7 possible matches (100% of possible matches) were achieved in the frequency/sub 2 category (p=.0002). 463 matches out of a possible 660 matches (70%) were achieved in the individual pulse section (p< .0001 for 463 or more matches). (Note: Possible matches in the general pulse section is equal to the number of subjects (10) multiplied by the number of choices per subject (11) on Assessment Form A. Possible matches in the individual pulse section is equal to the number of subjects (10) multiplied by the number of choices per subject. Possible matches in the sub pulse section is equal to the number of subjects for whom a match occurred in a previous pulse assessment stage: 1) the number of matches in the depth, intensity, amplitude, and frequency main pulse categories became the possible match numbers for corresponding Sub 1 responses; 2) the number of matches in the sub 1 pulse category became the number of possible matches for corresponding sub 2 responses. The decision not to examine results in cases where no match was achieved in a previous section was made in order to simplify interpretation (i.e.; if a general interpretation of the pulse is disparate as reflected in a no match, the interpretation of a corresponding lower level match (which represents a finer look at this general

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 8 of 11

assessment) is unclear.)

Validity of Pulse Diagnosis

Western medical theory contends that palpation of the radial artery pulse at the right and left wrist areas can not reveal diagnostic information about the stomach, lungs, pancreas, gall bladder, etc. as claimed by Traditional Chinese physicians. The following hypotheses were constructed to test this contention: H0 = correct matches between medical files and pulse profiles are the result of chance alone; there is no evidence to suggest that Traditional Chinese diagnosis is valid. H1 = correct matches between medical files and pulse profiles are not the result of chance alone; there is evidence to suggest that Traditional Chinese diagnosis is valid. Pulse/medical file matching results were considered significant in this study if the probability of occurrence by chance alone was <.05. The results were as follows: Dr. Broffman used the hand palpation method to achieve two correct 1st choices (p= .264 for two or more 1st choice matches to occur by chance alone), one correct 2nd choice (p= .322 for three or more 1st & 2nd choice matches to occur by chance alone), and three correct 3rd choices (p=.047 for six or more 1st, 2nd, & 3rd choices to occur by chance alone). Dr. McCulloch used a computer assisted electronic device to achieve two correct 1st choices (p= .264 for two or more 1st choice matches to occur by chance alone).

Discussion
Introduction
Several methodological approaches were considered in this investigation of Traditional Chinese pulse diagnosis; a design in which: 1) both Traditional Chinese physicians used hand palpation methods; 2) both Traditional Chinese physicians used electronic pulse detection methods; 3) one physician used the hand palpation method and the other used the electronic pulse detection method. The first two alternatives were rejected in favor of the third for two major reasons: 1) testing an electronic device was an essential part of this research 25 2) only one experienced electronic device operator was available in the San Francisco Bay area. It should be noted that the results achieved for the chosen approach (palpation/electronic) do not necessarily suggest what levels of validity and reliability would have been achieved had one of the other two approaches mentioned above (palpation/palpation; electronic/electronic) been used in the study. In other words, a low reliability finding in this investigation would not rule out the possibility that a high level of reliability could have been achieved if the electronic/electronic approach had been used. Lack of reliability in this investigation could be explained in any of the following eight ways: 1) electronic assessments of the pulse are accurate but hand palpation assessments are not as a consequence of improper palpation technique; 2) electronic assessments of the pulse are accurate but hand palpation assessments are not as a consequence of faulty interpretation of pulse findings; 3) hand palpation assessments of the pulse are accurate but electronic assessments are not as a consequence of improper sensor placement; 4) hand palpation assessments of the pulse are accurate but electronic assessments are not as a

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 9 of 11

consequence of faulty equipment; 5) hand palpation assessments of the pulse are accurate but electronic assessments are not as a consequence of faulty interpretation of pulse findings; 6) both electronic and hand palpation assessments are inaccurate as a consequence of improper measurement techniques; 7) both electronic and hand palpation assessments are inaccurate as a consequence of faulty interpretation of pulse findings; 8) both electronic and hand palpation assessments are inaccurate as a consequence of pulse diagnosis being nothing more than an artifact; A high level of reliability in the chosen palpation/electronic approach, however, does suggest that a high level of reliability would have been achieved if the electronic/electronic approach had been used.

Significant Results
In both the first section (general pulse) and third section (individual pulse) of Pulse Assessment Form A the physicians achieved a significant p<.OO01 result (79% and 70% of possible matches respectively). These sections dealt with: depth, intensity, amplitude, frequency, rhythm, length, type, temperature, quantity, texture, and width measurements of the pulse. In section two (sub pulse section) a significant p=.023 result (80% of possible matches) was obtained in the depth/sub 1 pulse category; a significant p=.0078 result (100% of possible matches) was obtained in the frequency/sub 1 pulse category; and a significant p=.0002 result (100% of possible matches) was obtained in the frequency/sub 2 pulse category. No significant findings were obtained in the remaining four categories (depth/sub 2, intensity/sub 1, intensity/sub 2, amplitude/sub 1), which represented 25%, 29%, 50%, and 29% of possible matches respectively. The above findings suggest that pulse diagnosis reliability goes down as more subtle levels of distinction are attempted. Other results suggest that there may be some validity to Traditional Chinese pulse diagnosis; in the pulse/medical file matching effort Dr. Broffman was able to achieve a statistically significant result (p<.047) for six or more correct 1st, 2nd, & 3rd choices. However, this conclusion must be tempered in light of the fact that a methodological problem was encountered which may have influenced the results. One subject with Alzheimer's Dementia behaved in a way that may have confounded the results of the subject/medical file matching effort. This subject was observed to "mumble to herself" (suggesting a mental condition) and forcefully wiggle her arms (suggesting resistance) on numerous occasions during the examination process. These two bits of information could have been used as additional clues in the matching selections made by the two physicians (a person with a mental condition such as Alzheimer's Dementia would be more likely to mumble and/or be resistant to the examination procedure than a person without this condition). It must be pointed out that although this additional information was available to the two physicians, there is no evidence that they took the information into account in their selection process. The fact that both Dr. Broffman and Dr. McCulloch achieved correct 1st choice matches on this subject could be purely coincidental and have nothing to do with a confounding variable. A second analysis was made in which the subject in question was not factored into the results. The highest probability under these circumstances was p<.l5.

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 10 of 11

It also questionable whether the use of second and third choice selections in the determination of statistical significance is a viable methodological approach. The fact that a statistically significant result was obtained only after second and third choice selections were taken into account may indicate an inherent lack of precision in Traditional Chinese pulse diagnosis that limits its clinical usefulness. An alternative explanation links this seeming diagnostic imprecision to incomplete symptom recording in On Lok medical files rather than any inherent weakness in Traditional Chinese pulse diagnosis. Often symptoms that are useless from a Western medical point of view can be the key that unlocks a diagnosis in Traditional Chinese medicine. For example, chronic canker sores helps in the diagnosis of a heart condition in Traditional Chinese medicine. Minor symptoms such as this could very well be left out of Western oriented On Lok medical files; thus putting the Traditional Chinese physicians at a distinct disadvantage in their matching efforts. If more minor symptoms had been recorded in On Lok medical files the two physicians may have achieved better results. (Note: A one out of three correct rate is not deemed acceptable by most physicians (Western as well as alternative practitioners) and patients, suggesting that only first choice selections should be included in a test of pulse diagnosis validity.) The physicians may also have fared better if they been Western-trained physicians in addition to being experts in Traditional Chinese medicine. Neither their prior training nor currently available resource books afforded them much help in accurately translating Western disease conditions into Traditional Chinese nomenclature; a process which was vital to the achievement of good results. The fact that the physicians did not have extensive experience diagnosing very old individuals (the mean age of the subjects was 80.5) who suffered from so many acute and chronic disease conditions may have been another impediment to their success. It also should be noted that Traditional Chinese physicians typically cross-check pulse diagnosis findings with other physical indicators in the body such as the tongue. When contradictory findings are found at any of these other sites the pulse profile is reexamined and any errors are corrected. This recovery process could render Traditional Chinese pulse diagnosis a useful diagnostic method even if the technique and/or its implementation is less than perfect. Had the physicians been allowed to look at each patient's tongue as well as examine her pulse they may have achieved better results.

Conclusion
More investigation of Traditional Chinese pulse diagnosis is needed before any definitive statement can be made about the reliability and validity associated with its use. Although the results of this preliminary investigation suggest that there may be some scientific basis for this ancient technique, its reliability needs to be substantially improved in key areas of the diagnostic process. As discussed earlier, it is unclear whether low reliability findings in this study are the result of operator error, faulty equipment, or improper interpretation of pulse findings. One of the key findings in this investigation was that the complex nature of traditional hand palpation virtually rules out its effective use by Western physicians in San Francisco; accurate pulse assessments by individuals who have only a superficial training in Traditional Chinese diagnostic techniques is not a realistic objective. The electronic pulse-taking device, however, does appear to hold great promise even though it did not successfully demonstrate its diagnostic capabilities in the test of pulse diagnosis validity. The

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005

Pulse Diagnosis

Page 11 of 11

positive results achieved in the general and individual sections of Pulse Assessment Form A (the test of reliability) suggest that further refinements in this technique could eventually lead to an effective and easy to use tool for pulse diagnosis in a more integrated dual health care system in San Francisco. Although pulse diagnosis basics (i.e.; hard versus soft pulse) can be learned in a relatively short period of time, the detection and interpretation of more subtle pulse forms are needed in order to perform an accurate and comprehensive diagnosis. The fact that that the electronic device is interfaced with a PC computer holds open the possibility that a partially or completely automated system of interpreting pulse patterns (according to the thirty recognized wave forms in Traditional Chinese medicine) could be developed. Efforts in this direction are already being made, and preliminary results are encouraging. This would substantially reduce the training needed to operate a device and shorten pulse administration and interpretation time to approximately 10 minutes. With the addition of this feature, Traditional Chinese pulse diagnosis could become: 1) highly accessible to Western physicians in San Francisco; 2) an effective means of helping bridge the gap between Western and Traditional Chinese systems of medicine in San Francisco. Questions, comments, or requests may be addressed to: Michael McCulloch, L.Ac. or Michael Broffman, L.Ac. at chinamed@well.com

Yin/Yang Symbol

Acupuncture.com
e-mail: AcuCom@aol.com

file://D:\Meus Documentos\ACUPUNTURA\Artigos\INTERNET\ACUPCOM\PULS...

2/11/2005