Are You a Pulse Master?

You've been there and so have I.

It was in my first diagnosis class in acupuncture school. Our assignment was to feel the patient's pulse and report what we felt. I was gung-ho (or naïve) enough to volunteer first. There I stood, eyes closed, concentrating on feeling something meaningful in that regular thumping heartbeat. To be honest, I had no idea what I was feeling, but I bravely put forth my best guess.

Then, the instructor took the pulse and felt something completely different. I wondered if I would ever learn this bit of magic called pulse diagnosis.

Historically, acupuncture was learned through apprenticeship. The student followed the master for years and learned to feel exactly what the master felt in the pulses. But, how many of us, today, have the opportunity to follow a master around for years to become excellent in pulse diagnosis?

The modern route usually consists of a four-year degree from an acupuncture college, followed by opening a practice. That's the route I took and I've come to realize first hand why it's called "practicing." I've practiced pulse taking a lot, learning from any master I can find, every chance I get.

What have I learned about pulses? First and foremost, they are subjective. Everyone who feels the pulses has a different perspective. Imagine yourself around a treatment table with 3-4 experienced practitioners. Most likely, each of them will have a different interpretation of the pulses, along with a different point prescription and pattern identification based on their own analyses. One instructor told me that it would take a lifetime to become really good at feeling pulses, and that what he felt now, after 20 years of practice, isn't what he felt previously. "So," I thought to myself, "was he right 20 years ago or is he only correct with his pulse diagnosis now? And what happens in another 10 or 20 years?"

Recently I took a class from Dr. Jake Fratkin (a master pulse diagnostician), where everyone in the room was asked to feel the pulses of the person next to them. We all felt the pulses and came up with our analysis. Dr. Fratkin then came around and gave his own interpretation for every pulse in the room. What did we learn? That we were all "wrong!" Every pulse that he came to evaluate was different than what we had felt individually. Dr. Fratkin has been practicing pulse diagnosis for over 30 years and is considered a "master." Most of us had been practicing between 3 and 10 years, and all had successful clinics, but none of us were "excellent" in pulse diagnosis.

And you know what? Even if we were all "masters" we would most likely still have different interpretations of the same pulses. That's just how this largely subjective art is practiced. Pulse diagnosis, as we know it today, has continued to evolve and change since its inception dating back to the early Han Dynasty (168 BCE). Over the years, different styles of pulse diagnosis have continued to evolve based on the interpretation of individual masters along the way. Today, we can choose from a variety of styles of pulse diagnosis, each with a slightly different interpretation. I am sure that each style was considered "perfect" by some master along the way.

A Modern Approach To Accurate Diagnosis

As modern technology has evolved, acupuncture has been a beneficiary. Much of the acupuncture practiced today is quite different than the techniques of ancient China. Sterile, stainless needles? Cupping without fire? Moxa without smoke? Laser treatment? Electroacupuncture? All of these modern acupuncture techniques are now commonly used and embraced by acupuncturists with excellent results.

But—how has diagnosis been enhanced by technology? To answer that question, I'll start with a little history.

Early in the 1950s Dr. Yoshio Nakatani, while treating an edematous patient with nephritis, discovered points around the patient's ankles that exhibited increased electrical conductance, when compared with surrounding skin areas. With a little more research he found that these points correlated with the traditional acupuncture points of the Kidney channel. When he examined multiple nephritis patients, he found that these same points were electrically active.

As he further refined his methods, he discovered lines of electrically conductive points corresponding to all the meridians. He also found that the electrical properties of these points revealed the underlying qi activity of each channel.

He called his technique Ryodoraku, which translates to "line of good electrical conductance." He spent the rest of his career perfecting his methods to be highly accurate and applicable to treatment.

Current advances:

Dr. Nakatani's "Ryodoraku technique" has evolved and advanced significantly since the 1950s. Now called "Digital Meridian Imaging," or DMI, current approaches use computerized testing and analysis to quantify qi balance in the meridians and make recommendations for treatment. With modern equipment, the test takes about two minutes and the computer interpretation is instant.

Meanwhile, the body of evidence exploring the electrical properties of acupuncture meridians continues to grow. You can find a list of more than 60 published research articles on the topic at www.RydorakuResearch.com.

So, what are the implications for acupuncture practice?

Before the modern advent of technology, the four pillars of diagnosis were the only way to diagnose a patient—looking, listening/smelling, palpation, and asking. And these methods, still the foundation of diagnosis, are greatly enhanced and complemented by including DMI in the list of tools at the acupuncturist's disposal. By using DMI in my practice over the last two years, I've identified the following strengths of this tool:

1. DMI is complementary to pulse diagnosis

What does a pulse really tell you? The pulses are indicators of how well the blood and qi are flowing through the meridians. DMI serves a similar function, illustrating energetic flow and blockages affecting the meridians and organ systems. Adding this information to what I learn from the pulses gives me a more complete picture of excess, deficiency, and even imbalances between the right and left sides of the same meridian. The result is that I have a more complete and objective picture of what's happening and I make a better diagnosis.

Traditionally, pulse diagnosis is used to monitor the patient's response to treatment, with the goal of creating a balance of qi and blood. With the addition of DMI, I now have the ability to objectively record, analyze and document progress and changes within the channels over a period of time. The patient's exam history is at my fingertips and the computer enhances my ability to see and document the patient's progress over time.

3. Patients love DMI

How many patients stop treatment too soon because they are not sure if acupuncture is really working? Or perhaps they feel better so they discontinue care before the changes have become permanent? Having the ability to show the patient a visual, objective status report of changes that have occurred since treatment began is very helpful in my practice. I find that the computer reports keep the patients more compliant with their treatment plans and encourage them into a long-term, preventative-care, treatment program. The end result is that they get the outcome they desire.

4. DMI is a practice builder

I've used DMI at health fairs and shows to draw people to my booth. I find that potential patients are VERY interested in this scientific and technological approach to acupuncture. It takes acupuncture out of the realm of the mysterious and into the comfort zone of technology. Even my long-term patients tell me that they never really "got" acupuncture until I showed them exactly what was happening in the computer report. Since adding DMI, my practice has more than doubled.

How can DMI help advance the field of TCM?

It really comes down to subjective evidence versus objective evidence—this is the missing link in our field of medicine. In a court of law, objective evidence is verifiable by a third party. Subjective evidence, on the other hand, is based on someone's opinion or what they believe. In the medical field, it's not much different. Subjective findings are based on the patient's own report of his/her condition, or the practitioners opinion of the patient's progress. The trouble with the subjective approach is that it's notoriously unreliable and not scientifically valid.

Objective findings, on the other hand, are used to substantiate a patient's diagnosis. Imaging studies, lab tests and performance measurements all substantiate the diagnosis. Because TCM practitioners do not typically use diagnostic tests, we are often accused of being "unscientific" and are relegated to the fringes of modern healthcare. An objective DMI report opposes this relegation by presenting objective evidence of the meridian system based on measurable, scientific parameters.

How do you introduce Digital Meridian Imaging to your practice?

Several manufacturers offer systems at various price points. Most are affordable by the average practitioner.

If you're looking for a DMI system, I have two pieces of advice. First, you'll need to differentiate between DMI and other approaches, commonly known as EAV, or Voll systems. EAV (Electroacupuncture according to Voll) is generally used to test and recommend supplements and remedies. The majority of the test points are not on acupuncture meridians at all. DMI, on the other hand measures directly on the meridians, usually on the Yuan source points, then makes acupuncture-based recommendations. Second, I suggest you comparison shop DMI systems—based on quality, ease of use, warranty, training, technical support, upgrades, guarantee, company staff, etc. In the end, the right system will prove to be a monumental benefit to your practice and your patients.

I didn't begin my acupuncture career until I was nearly 40. When an instructor told me it would take 30 years to become really good at pulse diagnosis, I wondered if I would ever make it in the field of acupuncture. I'm here to say that, while I continue to develop my skills in the ancient art of traditional pulse diagnosis, I am still an excellent acupuncturist. The combination of ancient wisdom and modern technology gives me an ample toolbox to give my patients the best possible results.