Hi Ingrid,

 

 

Now that I know the purpose of your inquiry, it becomes clearer as to what your possibilities are. The current DAOM program only have the capacity for quantitative analysis. A phenomenological approach to the matter could take five years. I recmmend you follow Sean's line of thinking on this for the kind of program that you are in.

 

W 

 

On 5/19/07, Ingrid <imparking@...> wrote:

Thank you Will, Dr. Walsh, and Are for your responses!  I will take all that was shared into consideration.  I am thinking about proposing this as my doctoral project and am trying to understand the different avenues of approaching pulse taking.  I know that as practitioners, our individual one-on-one with each patient is of the utmost importance in our private practice; hence my idea is that if there is more research geared in the direction to demonstrate the importance of pulse taking and its reliability, the importance of individualized treatments so often emphasized within our field may be understood (thus the difficulty in doing large-scale randomized controlled acupuncture studies and resulting in favor of acupuncture). 

I don't know if I'm out to prove anything more than to illustrate the benefits pulse taking has to the overall TCM practice as well as the complexity of each component of diagnosis in TCM is.  I think it can also help to educate folks that there is some method and reliability to the madness!  The funny thing with those who don't understand TCM, very few ask why we treat the way we do.  The big questions are what we do and how we go about it, but as in any medicine, diagnosis is the key to addressing the main health issue at hand.  Without proper diagnostic tools, we can treat biomedically, with acupuncture, or voodoo, and it would be a hit or miss ordeal without the correct diagnosis, whatever our tool may be.

Dr. Walsh, if the current paper or research gets published, I would be grateful to receive a copy or the literature citation.  Will, thank you for those references, I'll look them up to explore more!

Warm regards,
Ingrid

Sean Walsh <sean.walsh@...> wrote:

HHi Will,

Yes - there is also further work occurring with testing inter-rater agreement levels of practitioners using the Shen-
Hammer system. This is currently at an analysis stage and is being undertaken by a dedicated and knowledgeable
practitioner of this system to meet requirements for a research degree, and so I am not at liberty to discuss this further at
present. (But findings are interesting).

Emma and I also recently published a paper in the Journal of Complementary and Alternative Medicine (2006; US
publication) which looked at inter-rater agreement levels and testing of the left/right gender strength discrepancy
assumption discussed in the classical literature. (Males are stated as having a stronger left side pulse relative to their
right side and females are said to have a stronger right hand pulse relative to their left). While finding differences
between the strength of the pulse between the left and right sides, this wasn't sex depended. An interesting outcome in
the sense that if there were sex related differences then this would mean the validity of applying the Qi/Blood concept to
the Right/Left pulses would be invalidated. A real conundrum! Only a preliminary start and as usual more work through
replication by other research groups is required. There have been several other studies undertaken on the topic that pre-
date the work by Emma and I. However, these exist mainly in the form of thesis writings and are difficult to access. The
earliest study I've come across is by Cole, a UK study conducted in 1977.

In response to Ingrid's inquiry:
- intra and inter-rater reliability is important for any diagnostic system and even more so with pulse diagnosis because of
its inherent subjectivity. Ingrid identified the key to overcoming this - standardisation to the language and the method of
application. Once this occurs then any changes to the pulse are better attributed to the patient's health status rather
than to differences in pulse method. I understand that Hammer's pulse terminology/definitions were revised a few years
ago to address a few ambiguous terms for this reason.

As Are and Will noted you're still likely to find some personal interpretation and variation in agreement between people
feeling the same pulse - and this is due to a range of reasons, experience not the least of these. However, there should
be some level of agreement - this is the whole point of having a diagnostic framework to interpret findings within. Yet
there are two stages to the pulse diagnosis process. The first stage is the actual assessment of the pulse parameters.
Stage 2 is interpreting the assessment findings in a diagnostic framework. Hence even with a standard method and
language for describing the changes in pulse parameters is being undertaken, agreement levels between practitioners
could still break down in the diagnostic stage of using the pulse findings, attempting to understand the pulse changes in
a health context. Ingrid described this as 'nuances for interpreting'.

Ingrid's proposed study model also raises other questions in studying this area. Not least of which is how and when are
practitioners using pulse diagnosis: is it in combination with interview skills or as a stand alone technique? If in
combination with interview then it is necessary to ensure that 'questioning' doesn't influence the pulse assessment - or
should this be allowed to occur if practitioners are using pulse assessment in this manner in clinic? But then is the
reliability of pulse diagnosis being assessed if this was allowed to occur? As a stand alone technique the practitioner
could still be influenced by other non-pulse findings such as facial colour and posture. These would also need to be
controlled in a study situation when investigating pulse diagnosis. Or should they? It is interesting and depends upon
how pulse being used: Chinese/Oriental medicine is not a single system of practice.

Hope this helps(?)

Take care,

Sean.


Dr Sean Walsh, Ph.D.
Lecturer
Dept Medical and Molecular Biosciences
University of Technology, Sydney

----- Original Message -----
From: William Morris

Date: Friday, May 18, 2007 11:33 pm
Subject: Re: [PulseDiagnosis] Info
To: PulseDiagnosis@yahoogroups.com

> 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
> amplitudeand 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*
> mayallow 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
> positivisticscientific 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'sexperiences 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.
>
>
> Ingrid, all this said, we do have some studies (see below), and I
> am not
> sure if there are more at this time. They are reasonable designs
> and you
> should be aware of this work if you are setting out on this course.
> SeanWalsh is on the list and participated in the first study below.
> Sean, do you
> know of any further work in this area?
>
>
>
> 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.
>
>
>
>
>
>
>
>

> On 5/18/07, Are Thoresen wrote:
> >
> > *We must remember that the mere presence of the therapist will
> > influence the pulses of the patient.*
> >
> > *Also that the pulse tend to show how that special therapist
> should treat


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