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Basic data concerning TCM diagnosis. - As mentioned above, our TCM books don't provide us with any numerical data concerning the results of TCM diagnosis. So we'd like to ask you: Which pulses and which tongue images have been found among the patients of your hospital last year? Which was the most frequent, the second, the third? Has there been any change, compared to the situation 30 years ago?
Which of the BAGANG criteria (YIN-YANG, heat-cold, excess-deficiency, exterior-interior) have been found among your patients with which frequency?
Which TCM syndrome patterns or diagnostic classifications like “kidney weakness” (SHEN XU) or “Liver fire” (GAN HUO) etc. have been diagnosed most frequently? Which one was number one, two, three, four?
Are there, concerning these aspects, any differences in different parts of China? Or any differences, compared to the situation in former times?
And as to Chinese teachers working abroad: Did they find any differences between China and abroad, concerning "normal" pulse and tongue? Any differences concerning abnormal pulses? Any differences concerning the syndrome patterns you found?
Diagnostic properties of acupuncture points. - In theory, diagnostic properties of acupuncture points seem to be very important. But in the clinical part of the books, this aspect is hardly ever mentioned, and in clinical practice, even less. There might be two reasons for this discrepancy.
Possibility A: These diagnostic properties are really existing, but only in those severe cases which are no longer treated or diagnosed by TCM methods.
Possibility B: This is another of many examples where theory and clinical work are two different worlds, and in fact these diagnostic abilities of acupuncture points have been postulated by philosophers, but never been confirmed when treating patients.
Or could anyone prove that the supposed diagnostic properties of acupoints are really valuable?
Aversion to heat, cold etc. - These diagnostic signs, too, are very much dependent on the environment. People used to heating and air condition, keeping the room temperature constantly at 22 centigrade, will have an aversion to heat and cold as well. So, all these conditions have to be checked, considering two aspects:
First, if they can be used equally in hot and cold regions, or in countries accustomed to heating and air conditioning.
Second, if they are really useful in these kinds of diseases which nowadays are mainly treated with acupuncture (like local pain, allergies, functional and psychosomatic conditions) or with TCM herbs.
TOU YUN and similar symptoms. - “TOU YUN (“dizziness”) is very frequent in China but less frequent in Western countries. Thus, it might be interpreted as some kind of “cultural” symptom. Maybe this has something to do with the economic situation: In the bad times, when a major part of the Chinese population lived on the edge of starving, it may have been natural that symptoms connected to this situation were very important. Nowadays the majority in the cities is well nourished, so these symptoms should have become less in everyday clinic. But do the case documentations of your hospital confirm this expectation?
However, there are some symptoms which patients doesn’t necessarily mention by themselves, but always confirm when the doctor asks for it. “Did you feel some fatigue during daytime recently?” - Yes, we did in fact. “Some stiff feeling of the lower back frequently?” - Yes, indeed. - Maybe, TOU YUN in China has become one of these welcome little symptoms which are not threatening at all but can help to convince the doctor and the patient that some rest and some good food might be helpful.
As mentioned above, TOU YUN is much less frequent in Western countries. So, such symptoms have to be reconsidered, at least when transmitting TCM to foreign countries. Again the question is: What about the experiences of Chinese doctors in China and abroad?
Which of the ancient pulse forms and syndromes described dangerous conditions? - In ancient times, the doctor had no duty to intervene in hopeless cases. If he did, he was made responsible if someone died. So, when being called to a patient, the first thing was to judge if the condition was hopeless or extremely dangerous. If it was, the doctor would not do anything, but refuse the treatment and return home immediately.
So we have to ask: Which of the ancient syndrome descriptions and which of the many pulse forms actually meant hopeless or life-threatening conditions? So that they were not really a guideline for treatment, but in fact for the refusal of treatment?
Today, even the most ardent TCM friends will agree that severe acute and highly dangerous conditions are the field of modern scientific medicine, which not only has better means of treatment for these cases, but also better means of diagnosis. So the classical syndromes and diagnostic hints should be checked according to this question. Those ones which originally should warn the doctor not to start a treatment should be marked accordingly.
Are blind people especially good at feeling the pulse? - Blind people are said to have special massaging abilities. This should be the case, too, when dealing with pulse diagnosis, but we don’t find much about this aspects in our books. Are there researches or reports concerning this question?
Pulse diagnosis for unbelievers. - We believe that Chinese doctors can reveal marvelous things just checking the radial arteries. Unfortunately, there are still some people in our countries not believing it. So, why not convince them with two simple tests?
Test 1: Let 20 TCM doctors check the pulses of 20 randomly chosen patients, without seeing anything but the hand. Let them write down:
A) pulse characteristics,
B) pathological conditions felt by the pulse,
C) the state of "Lung", "Spleen" and the other organs according to the CUN, GUAN and CHI position of the right and left hand.
Are their findings more or less the same? Do they correctly diagnose the patient's main condition? We are sure they will.
Test 2: Let the same doctors check the pulse of the same 20 patients a second time, but in a different sequence. Let them write down:
A) which pulse belongs to which patient,
B) which pulse characteristics, pathological conditions and state of the organs do they find this time?
If the majority is able to confirm the findings of the first test, this would be a definite proof. Thus, these Western unbelievers will be silenced forever, and the fame of TCM will spread all over the world. We only have to fix a time and a place and inform the international TV teams ... who is willing to participate?
Can Westerner fully master TCM pulse diagnosis? - Even in Western countries, there are TCM authors re-telling us China's pulse lore: Different pulses left and right, different pulses superficially and in depth, different in men and women, different pulses at the CUN, GUAN and CHI location, each one indicating the state of one ZANGFU organ.
As to ourselves, we have to admit again that we have been rather stupid and unable pupils. We never managed to get any useful information out of the differences of CUN, GUAN and CHI position. So we don't teach it to our students, because, being rather old-fashioned, we think that a teacher should master the art which he expects his students to learn.
Nevertheless, we don't have the slightest doubt that eminent Western TCM experts like Mr. Porkert or Mr. Maciocia have perfectly mastered the art of Chinese pulse diagnostics. Just to silence the unbelievers, we heartily invite them to participate in the test suggested above, so that we can praise their talent even more loudly.
But what do our Chinese friends think? Have they ever met Westerners whose hands and minds had the same skills as some Chinese? Or do they think that they are just repeating old fairy tales they read somewhere else?
Pulse diagnosis for dummies. - The "Outline of Chinese Acupuncture", published in 1975, didn't talk about pulse diagnosis at all. The "Essentials" in 1980 presented 12 abnormal pulses, plus the bold theory from the HUANGDI NEIJING (never to be applied in the clinical parts of any of these books) that at the CUN, GUAN and CHI positions of the right hand the state of Lung, Spleen and Kidney could be felt, and heart, liver and second kidney at the respective positions of the left hand. (Real TCM hardliners, especially some US-Americans, declare to believe that this is only valid for males and just the other way round in females). "Chinese Acupuncture and Moxibustion", published 1987, increased the number of abnormal pulses to 17. And the "Newly compiled Practical English-Chinese Library of TCM" returns to the classics and increases the number of abnormal pulses to 24. Without expressing the slightest doubt, these authors repeat the old tales that at the left GUAN pulse position not only the liver can be felt, but also the gallbladder, and on the right GUAN position not only the spleen, but also the stomach.
Again, theoretical and clinical parts of these books are different worlds: These marvelous abilities of the six radial pulse positions (making 12 when considering superficial and deep pulse and even 18 when we further specify a middle layer, as suggested by the honorable Mr. Maciocia) never appear in the clinical parts of our TCM books.
And this is why we insist upon numbers and figures so stubbornly. If you can really judge the state of different organs at different places of the radial arteries, please prove it by means of the case documentations of your hospital. If not, better don't tell these stories anymore, even if stated in ancient scripts.
Or are there really some important reasons to stick to the classics even in those aspects never being used clinically today?
SUN SIMIAO and the superior doctor. - SUN SIMIAO is said to have stated: "The skilful doctor knows what is wrong by observing alone, the mediocre doctor by listening, and the inferior be feeling the pulse." Does anyone believe this? Or, maybe, this was true at his time, but exaggerated today? Or, if he really said it, that it was just showing off, even at this time?
Many pulse locations. - Ancient scripts (for example the HUANGDI NEIJING) recommend much more than today's 3 locations to check the pulse, e.g. the carotid artery. This seems reasonable even from the point of view of modern medicine. So that we have to ask: Why did so many obscure concepts remain in TCM theory until today, whilst this really useful aspect was reduced to just one location (and then popped up with some fairy tales about what could be felt at CUN, GUAN and CHI)?
Pulse diagnosis and society. - According to the theory of pulse taking, a person's constitution as well as his actual pathological condition is reflected in his pulse. Men and women, old and young, sportsman and couch potato, worker and manager, peasant and writer - all this should be in the pulse. There should be a difference of the "normal" pulse in the cities and in agricultural areas. Why do we find so little about these differences in our books?
Pulse diagnosis in foreign countries. - If a patient's constitution can be palpated clearly by his pulse, there should be a difference concerning the "normal" pulse in China and in foreign countries, where there are much more people with overweight, and much less people doing manual work. Many Chinese TCM doctors have been working abroad. Why don't we read anything about their experiences in the books which claim to have been written for us?
Pulse patterns before, during and after a disease. - When someone is taken to the hospital because of extremely high fever, of course the temperature is mentioned again when the patient is declared cured and sent home. If a certain pulse pattern is really typical for a certain pathological condition, it should return to normal after successful treatment. However, this remark is missing in most case histories in our books.
This questions could be easily answered by checking the case documentations in Chinese hospitals: Is this a rule, or is it an exception? If it should be the rule, it would be another hint that the role of traditional pulse patterns is much less important than stated in the books and should be reconsidered.
Pulse diagnosis and graphic devices. - In older books, there have been some efforts explaining Chinese pulse patterns by means of plethysmographic pulse curves. During the last years, these graphic devices have become really precise and sophisticated. So it is quite astonishing that recently published books like the "Practical Chinese-English Library of TCM" don't even try give us some clear idea of the traditional pulse forms by showing us their respective plethysmographic curves. What does that mean? Is there no research done in this question anymore? Did the specialists stop believing that these pulse patterns can really be confirmed by checking pressure and blood flow? But, then, why do they tell us about what they themselves do no longer believe in?
Modern and traditional pulse patterns. - It is quite funny that there are still some TCM books speaking of normal pulse frequency in relationship to breathing, the normal pulse meaning 4-5 beats per breath. Does this mean that even the use of a wrist watch should be avoided?
Pulse taking is an important means of modern medicine, too. Frequency, regularity, superficial or deep pulse, hard or soft pulse give important hints, especially when combined with blood pressure and electrocardiogram. So, we consider concepts like comparing the pulse to the frequency of breathing rather ridiculous. But maybe someone disagrees?
Tongue Diagnosis in the cities and in the countryside. - As life-style and nourishment are quite different in the cities and in the countryside, there should be some difference in the "normal" tongue. We don't find much about this aspect in our books. So we should like to learn from Chinese experience.
Tongue diagnosis and the changes in society. - 30 years ago, it was still a compliment in China to say to somebody: "You've become stouter!" (NI PANGLE). Today, citizens in Chinese cities have the same problem as the Westerners: hoping to keep fit and slim, but constantly in danger to get fat. So, nobody likes to hear this compliment any more.
It seems natural that such a change in urban society should be accompanied by a change of the "normal" (at least the average) tongue. TCM schools and academies have been taking tongue photos since decades. So they should be able to prove the value of this ancient diagnostic method by reflecting social change in a change of tongue images.
Surprisingly, we don't find anything about this aspect in our TCM books either. But if there has been anybody researching this question and can tell us something about it, we'll be eager to hear about the results.
Tongue diagnosis abroad. - During the last 30 years, thousands of Chinese TCM doctors have been working abroad. Did they find any difference in "normal" and pathological tongues, comparing the Europe or the USA with China? And if they did: Why don't we find any of these experiences in the books supposedly written for us foreigners?
Clinical value of "8 criteria" (BA GANG). - We consider the classification of a syndrome according to YIN and YANG as highly useful, as well as the classification according to "Hot / Cold" and "Deficiency / Excess" (XU / SHI). We have some doubts, however, about the categories "Exterior / Interior" (BIAO / LI). For example, the symptoms of a stroke should start "exteriorly" and go on "interiorly". But the etiopathology of apoplexy, for example, doesn't give any reason for this way of advancing, and the same is the case with many other diseases.
Nevertheless, we consider the BA GANG a highly valuable diagnostic tool, worth to be integrated into the modern medical curriculum. Any Objections?
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