There are pulse features that remain and those that change.

The variables that Are is suggesting could be called the affect of the clinical interaction on the neurohumeral and neurovascular reflexes. The weaker the person, the more changeable they are. The more functional the disturbance, the more changeable it is and the more structural or substantive pathology will tend to change less.    

One set of features that impact changeability from practitioner to practitioner includes the depletions of essential substances. When shen is depleted the rate, amplitude and force can become inconsistent. The signs of depletion in the pulse such as thinness, lack of force, lack of amplitude and lack of root all reflect scenarios where the pulse can be more difficult to label. This is due to inconsistencies that occur when the heart gains qi and blood during a resting cycle and uses qi and blood during an activity cycle whether this be physical or emotional. Further, if the pulse has signs of qi depletion, then the wei qi and character armoring may be involved.

The excess pulses in general are more likely to present consistently regardless of the practitioner. Pulses that do not tend to change under the influence and presence of others include atherosclerotic pulses (Hammer's ropy), bounding and forceful pulses, drumskin and full pulses. Or take deep cotton; this pulse tends to reflect a depletion state and is typically very difficult to create change.  

These considerations are different than those pulse assessments that reflect a difference in volume from one position to another. Take for instance the diaphragm, if you get the patient to laugh, this pulse may very easily change. If the qi accumulates in an organ such as the spleen and there is also damp and qi depletion, then the qi may not easily flow towards the kidney or the heart. However, conversations that affect the yi and consciousness of possibilities or treatments that boost spleen qi may allow this qi to flow downstream and nourish the heart or kidney. The qi flow from spleen to kidney is the night time wei qi flow along the controlling cycle and the ying qi flow from the spleen to the heart is the channel clock flow.]

Ingrid – as far a demonstrating inter-rater reliability is concerned, this can be done. But you must set out to intentionally prove it. One could more easily set out to intentionally disprove inter-rater reliability. Either way – what has one proven?

In order to prove inter-rater reliability, certain problems in pulse diagnostic education have to be discussed. Take for instance level of pressure. If I press into the blood stream, I am far more likely to call the pulse slippery than if I press to the vessel wall. Here is the number one cause of inconsistent findings from practitioner to practitioner regarding a slippery or a bow-string label. Just as we could look at the proving or disproving of inter-rater reliability, we can find the slippery or bow-string depending on whether we focus on turbulence or tension.

Could it be that pulse diagnosis has value and significance outside of positivistic and mechanistic Newtonian science? Has our culture gone so far in to a need for evidence that we cannot see the obvious? The current devastation of the ecosphere is a byproduct of mechanistic and positivistic scientific values. We have to find a different way. Our body of evidence must become less biased towards quantitative assessments and embrace qualitative approaches to inquiry.

I am not sure that proving pulse diagnosis inter-rater reliability is as valuable as accurate and detailed reflections in the case notes. Full bodied phenomenological descriptors of both the practitioners and the patient's experiences will go a long way towards developing our conversations about pulse diagnosis. Case series within a group of practitioners who are sharing a common inquiry into pulse diagnosis – plus a series of interviews by an expert would also help in developing our body of knowledge.

King E CD, Ryan D, Walsh S, Ryan D. The Reliable Measurement of Radial Pulse Characteristics. Acupuncture in Medicine. December 2002;20 (4)(December):150.

King E CD, Ryan D. The reliable measurement of radial pulse: gender differences in pulse profiles. 1: Acupunct Med. December 2002;20(4):160-167.