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Re: [PulseDiagnosis] Info

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  • Ingrid
    Hi Will, Thanks for sharing this forum over the past 7 years! I have a question for all of you out there studying pulses about a possible research question.
    Message 1 of 11 , May 17, 2007
    • 0 Attachment
      Hi Will,
      Thanks for sharing this forum over the past 7 years!

      I have a question for all of you out there studying pulses about a possible research question.  There is always the individual practitioner's interpretation of pulse; however, there should be some sense of inter-rater reliability. I know this is one of the reasons Will, as well as Dr. Shen and Hammer's other students, have been teaching pulse taking, so that discussions based on pulses can be understood by more than one or two individuals.

      Would it be possible then to demonstrate to the academic world, namely the medical field, how pulse taking is a reliable method of diagnosis?  My proposal is to begin with a small study with 5-7 practitoners that all have similar amounts of training and pulse taking backgrounds, interview patients only by taking their pulses and doing a basic TCM diagnosis.  If these individual practitioners are able to give very similar to same diagnoses without the other interview skills used for diagnosis, there would be a small but useful demonstration of how acupuncture works from the diagnosis to the treatment.  This is of course useful for allowing academia to say, yes, this is a reliable method of diagnosis and even though we don't know how acupuncture works itself, it demonstrates the individualized diagnoses that is used in treatment, even if the individuals all have the same allopathic diagnosis.

      Have there been any demonstrations of such? and where could I find information on this?  My interest in this is from a patient who was curious as to what my interpretation of his pulses were in comparison to another practitioner's and how reliable the diagnostic procedures were for TCM.  I know there are many nuances with pulse diagnosis, but there are also nuances for interpreting a CAT scan or MRI and the better the practitioner or the more reliable the diagnositic technique, the more solid of a diagnosis can be made. 

      Thanks for your input!
      Ingrid Park


      WMorris116@... wrote:
      Dear All -

      We have approximately 688 members from all over the world. The list has grown as we aproach our 7th anniversary on May15.

      Those of you who are new will find in the archives among the 3,332 messages some important discussions and pearls. Some of them from pulse significant diagnosis teachers who have passed away including Rory Kerr and James Ramholz. Also, be sure to check the files section. There are some great pulse diagnosis resources. For example Robert Baptist has a chart that provides an overview of neoclassical methods.

      Will
       
      William R. Morris, DAOM, MSEd, LAc
      President Emeritus, AAAOM
      2700 Anderson Ln 204
      Austin, TX 78757
      512-454-1188













      AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.


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    • Are Thoresen
      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
      Message 2 of 11 , May 18, 2007
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        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.

        The pulses may thus show quite different picture for different therapists.

         

        Are

         

        Are Thoresen

        Gisleröd

        N-3175 Ramnes

        arethore@...

        http://home.online/~arethore/

         


        Fra: PulseDiagnosis@yahoogroups.com [mailto:PulseDiagnosis@yahoogroups.com] På vegne av Ingrid
        Sendt: 17. mai 2007 23:06
        Til: PulseDiagnosis@yahoogroups.com
        Emne: Re: [PulseDiagnosis] Info

         

        Hi Will,
        Thanks for sharing this forum over the past 7 years!

        I have a question for all of you out there studying pulses about a possible research question.  There is always the individual practitioner' s interpretation of pulse; however, there should be some sense of inter-rater reliability. I know this is one of the reasons Will, as well as Dr. Shen and Hammer's other students, have been teaching pulse taking, so that discussions based on pulses can be understood by more than one or two individuals.

        Would it be possible then to demonstrate to the academic world, namely the medical field, how pulse taking is a reliable method of diagnosis?  My proposal is to begin with a small study with 5-7 practitoners that all have similar amounts of training and pulse taking backgrounds, interview patients only by taking their pulses and doing a basic TCM diagnosis.  If these individual practitioners are able to give very similar to sa! me diagnoses without the other interview skills used for diagnosis, there would be a small but useful demonstration of how acupuncture works from the diagnosis to the treatment.  This is of course useful for allowing academia to say, yes, this is a reliable method of diagnosis and even though we don't know how acupuncture works itself, it demonstrates the individualized diagnoses that is used in treatment, even if the individuals all have the same allopathic diagnosis.

        Have there been any demonstrations of such? and where could I find information on this?  My interest in this is from a patient who was curious as to what my interpretation of his pulses were in comparison to another practitioner' s and how reliable the diagnostic procedures were for TCM.  I know there are many nuances with pulse diagnosis, but there are also nuances for interpreting a CAT scan or MRI and the better the practitioner or the more reliable the diagnositic technique, the more solid of! a diagnosis can be made. 

        Thanks for your input!
        Ingrid Park


        WMorris116@AOL. COM wrote:

        Dear All -

        We have approximately 688 members from all over the world. The list has grown as we aproach our 7th anniversary on May15.

        Those of you who are new will find in the archives among the 3,332 messages some important discussions and pearls. Some of them from pulse significant diagnosis teachers who have passed away including Rory Kerr and James Ramholz. Also, be sure to check the files section. There are some great pulse diagnosis resources. For example Robert Baptist has a chart that provides an overview of neoclassical methods.

        Will

         

        William R. Morris, DAOM, MSEd, LAc
        President Emeritus, AAAOM
        2700 Anderson Ln 204
        Austin, TX 78757
        512-454-1188












        AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.

         

         


        Need a vacation? Get great deals to amazing places on Yahoo! Travel.

      • William Morris
        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
        Message 3 of 11 , May 18, 2007
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          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.

           

          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. Sean Walsh 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 <arethore@...> 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.

          The pulses may thus show quite different picture for different therapists.

           

          Are

           

          Are Thoresen

          Gisleröd

          N-3175 Ramnes

          arethore@...

          http://home .online/~arethore/

           


          Fra: PulseDiagnosis@yahoogroups.com [mailto:PulseDiagnosis@yahoogroups.com] På vegne av Ingrid
          Sendt: 17. mai 2007 23:06
          Til: PulseDiagnosis@yahoogroups.com
          Emne: Re: [PulseDiagnosis] Info

           

          Hi Will,
          Thanks for sharing this forum over the past 7 years!

          I have a question for all of you out there studying pulses about a possible research question.  There is always the individual practitioner's interpretation of pulse; however, there should be some sense of inter-rater reliability. I know this is one of the reasons Will, as well as Dr. Shen and Hammer's other students, have been teaching pulse taking, so that discussions based on pulses can be understood by more than one or two individuals.

          Would it be possible then to demonstrate to the academic world, namely the medical field, how pulse taking is a reliable method of diagnosis?  My proposal is to begin with a small study with 5-7 practitoners that all have similar amounts of training and pulse taking backgrounds, interview patients only by taking their pulses and doing a basic TCM diagnosis.  If these individual practitioners are able to give very similar to sa! me diagnoses without the other interview skills used for diagnosis, there would be a small but useful demonstration of how acupuncture works from the diagnosis to the treatment.  This is of course useful for allowing academia to say, yes, this is a reliable method of diagnosis and even though we don't know how acupuncture works itself, it demonstrates the individualized diagnoses that is used in treatment, even if the individuals all have the same allopathic diagnosis.



          Have there been any demonstrations of such? and where could I find information on this?  My interest in this is from a patient who was curious as to what my interpretation of his pulses were in comparison to another practitioner's and how reliable the diagnostic procedures were for TCM.  I know there are many nuances with pulse diagnosis, but there are also nuances for interpreting a CAT scan or MRI and the better the practitioner or the more reliable the diagnositic technique, the more solid of! a diagnosis can be made. 

          Thanks for your input!
          Ingrid Park


          WMorris116@... wrote:

          Dear All -

          We have approximately 688 members from all over the world. The list has grown as we aproach our 7th anniversary on May15.

          Those of you who are new will find in the archives among the 3,332 messages some important discussions and pearls. Some of them from pulse significant diagnosis teachers who have passed away including Rory Kerr and James Ramholz. Also, be sure to check the files section. There are some great pulse diagnosis resources. For example Robert Baptist has a chart that provides an overview of neoclassical methods.

          Will

           

          William R. Morris, DAOM, MSEd, LAc
          President Emeritus, AAAOM
          2700 Anderson Ln 204
          Austin, TX 78757
          512-454-1188












          AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.

           

           


          Need a vacation? Get great deals to amazing places on Yahoo! Travel.




          --
          William R. Morris, DAOM
          President Emeritus, AAAOM
          Editor in Chief, American Acupuncturist
        • Sean Walsh
          HHi Will, Yes - there is also further work occurring with testing inter-rater agreement levels of practitioners using the Shen- Hammer system. This is
          Message 4 of 11 , May 18, 2007
          • 0 Attachment
            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 <wmorris33@...>
            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 <arethore@...> 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
          • Ingrid
            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
            Message 5 of 11 , May 18, 2007
            • 0 Attachment
              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


              The mission of this group is to provide a forum for the discussion of pulse diagnosis so that a depth of understanding is furthered.
              Yahoo! Groups Links

              <*> To visit your group on the web, go to:
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            • William Morris
              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
              Message 6 of 11 , May 19, 2007
              • 0 Attachment
                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.
                 


                 
                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


                The mission of this group is to provide a forum for the discussion of pulse diagnosis so that a depth of understanding is furthered.
                Yahoo! Groups Links

                <*> To visit your group on the web, go to:
                http://groups. yahoo.com/group/PulseDiagnosis/

                <*> Your email settings:
                Individual Email | Traditional

                <*> To change settings online go to:
                http://groups.yahoo.com/group/PulseDiagnosis/join
                (Yahoo! ID required)

                <*> To change settings via email:
                mailto:PulseDiagnosis-digest@yahoogroups.com
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                PulseDiagnosis-unsubscribe@yahoogroups.com

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                Luggage? GPS? Comic books?
                Check out fitting gifts for grads at Yahoo! Search.




                --
                William R. Morris, DAOM
                President Emeritus, AAAOM
                Editor in Chief, American Acupuncturist
              • Are Thoresen
                Ingrid, Interesting project, but I guess that the results will be the same as when the Norwegian Medical Journal tried to evaluate the “Dowsers” of Norway.
                Message 7 of 11 , May 20, 2007
                • 0 Attachment

                  Ingrid,

                  Interesting project, but I guess that the results will be the same as when the Norwegian Medical Journal tried to evaluate the “Dowsers” of Norway . Lay-lines are quite real, and give disease if people have their bed upon them, and so on. Quite many effects. The dowsers feel these lines quite real (I do too). So, 10 of the most gifted dowswers were asked to draw a lay-line-map over a specific area. When looking at the maps after, they were totally different. Although the dowsers did have good results in “treating” people (moving their bet when they were sick, often extraordinary good results), they had different findings. The same I have seen in pulse taking; different diagnostics have different results, but in treating they may have equal good results. And the pulse-findings of the other therapists change or normalize also if they examine the patient again, after the treatment of one of them after his finding, even if his finding did not correlate with the others. Interesting.

                   

                  Are Thoresen

                  Gisleröd

                  N-3175 Ramnes

                  arethore@...

                  http://home.online/~arethore/

                   


                  Fra: PulseDiagnosis@yahoogroups.com [mailto:PulseDiagnosis@yahoogroups.com] På vegne av William Morris
                  Sendt: 19. mai 2007 19:23
                  Til: PulseDiagnosis@yahoogroups.com
                  Emne: Re: [PulseDiagnosis] Info

                   

                  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.

                   



                   

                  On 5/19/07, Ingrid <imparking@yahoo. com> 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@uts. edu.au> 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
                  > positivisticscienti fic 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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