"treatise On The Six Classics Syndrome Pulse Study

Most patients who seek Chinese medicine in the west are unfamiliar not only with theory, but with the language with which this medicine has been communicated over the centuries. Any one practicing Chinese medicine for any length of time in the West begins to understand how Westerners experience such problems as focal distention and a stilling sensation in the chest. This constant process of translation is one reason why many western practitioners of Chinese medicine emphazise the use palpation as it allows to directly interact with patients. Similarly while we find that classic formulas can be extremely useful for Western patients, sometimes it is hard to see how their complaints match the description given in textbooks or as described by the historical sources or modern textbooks and case histories. Pulse diagnosis can help bridge this gap and can be a useful tool not only in the clinic, where a grounding in the practicalities of treating patients gives it added importance, but also in helping us understand the connections between theory and practice in our medicine. This investigation of pulse in the Discussion of Cold Damage was framed to address these issues.Pulse diagnosis is one of the hallmarks of Chinese medicine with roots going back at least as far as the Warring States period and clear textual and archaeological evidence from the Western Han dynasty. It is a major feature of all the Chinese medicial classics, including the Yellow Emperor's Inner Classic, Classic of Difficulties, Discussion of Cold Damage, and Essentials from the Golden Cabinet.The study of pulse diagnosis in the Discussion of Cold Damage is put in context by briefly outlining the salient features of the pulse in the books that preceded it, including the passages on medical practitioners from Sima Qian's Historical Records. We see that by the time of Zhang Zhongjing the basics of pulse diagnosis using the radial pulse have been set by books that he acknowledges in his preface, both parts of what became the Inner Classic and the Classic of Difficulties. In these texts the pulse is used to judge the location, quality, and depth of disease.One of the hallmarks of the Discussion of Cold Damage is its usage of yin and yang as an organizing principle at every level. This includes the pulse. In Zhang Zhongjing's approach to the pulse every bit of information is filtered through a yin-yang sieve, such as quality of disease, its location in the body, and its depth. The pulse is also used in this book to deduce the history, predict the prognosis, and sometimes even to stand in for the pathodynamic and the rest of the presentation. Zhang does not go overboard in this regard, as he realizes that the pulse is only one aspect of the examination and must be used in context. For this reason,sometimes the pulse is not given much importance and instead diagnosis is based on the rest of the presentation.The main ways in which pulses in the Discussion of Cold Damage have been studied are historical and textual analysis as well as research into the connections between differentiation of patterns and diseases. Recently research into the pulse aspects of the Discussion of Cold Damage have studied one of the following aspects of the issue: single pulse qualities, the relationship between the pulse and changes in the disease process, utilizing the pulse as an organizing principle to understand some aspect of the book, the import of specific pulses in specific paragraphs, as well as more generalized approaches. While some writers have addressed pulse diagnosis in the Discussion of Cold Damage from the perspective of the differentiation of six stages presentations, as far as I know none have systematically probed the relationships between the presentations and pathodynamics of the six stages, the presentations of the individual formulas, and the pulse.The above are two of the salient features of the Discussion of Cold Damage and any research into any aspect of this text and its tradition has to focus on them. In this dissertation we first give an overview of the pulse as an emblem for each of the jing and then go into detail discussion of how the pulse relates to the more important formulas in the largest section of the book, that dealing with greater yang diseases and related disorders.The second section of this dissertation is a brief overview of the classic pulses for each of the six stages. The pulse is only mentioned explicitly in two of the paragraphs that are generally considered to manifest the main points of a stage. That is the greater yang, with a floating pulse, and the lesser yin, with a pulse that is submerged and faint. To come up with a typical pulse for the other stages requires looking at a few paragraphs, and this process is in some ways problmeatic.The third section goes into detail for twenty-one of the most important formulas considered under the greater yang rubric. For each formula a brief overview of the presentation is given along with the pathodynamic as well as a discussion of how the pulse figures into the equation. When the author has any significant experience with the formula in question, it is noted at the end. In regards to these formulas, not even half have pulses that are clearly stated in the text, agreed upon by commentators, and used an important clinical markers by modern clinicians.. For the most part if the original text did not discuss the pulse, most commentators did not remark upon it and there was wide variation is the pulses decribed in modern case histories.The result is clear, although perhaps not surpring. Pulse examination, although a major component of the diagnostic process in Chinese medicine is not depended upon exclusively inthe clinic. While it is useful to push our skills in this regard, the Discussion of Cold Damage and its tradition teaches us to be modest when interpreting the pulse.