| BackgroundDiagnosis by pulse-taking is the principal content of pulse-taking in the four ways of diagnosis of Traditional Chinese Medicine. At present, there are28diagnoses by pulse-taking to examine illnesses in the clinical. Hence, the main substance of diagnoses by pulse-taking is the characteristics of pulse conditions and their clinical meanings.The moderate pulse is one of the28pulses. Nonetheless, there are inconsistencies in the description, regarding the characteristics of pulse conditions and their clinical meanings on the related teaching materials and monographs on sphygmology, among the higher Traditional Chinese Medicine institutions nowadays, so far as to substitute some concepts for others surreptitiously and cause contradiction in logic. These realities impact directly on instructing the clinical practice and passing on and carrying on concerning diagnosis by pulse-taking in Traditional Chinese Medicine.How was the moderate pulse expounded in the documents from Chinese ancient times? Mow do people understand the moderate pulse nowadays? What connotations ought to be given to the moderate pulse? In view of these questions, it is significant, in value of theories and meaningfulness of actuality, to launch the research of documents on the moderate pulse.ObjectiveThis study is a preliminary to put forward means for solving the above problems-by exploring the forefathers" developing trajectories in understanding the moderate pulse, analyzing the main causes in the confusion of the moderate pulse at present, and combining with the clinical closely. This study is to provide a foundation for:1). standardizing or regulating the characteristics of pulse conditions in the moderate pulse;2). the clinical meanings of the moderate pulse;3). enhancing the practical value of the moderate pulse.Methods1. The research of documents on the features of pulse conditions of the moderate pulse and their clinical meanings1.1Study on documents of Chinese ancient times:Summarizing the understanding on sequence of ideas and the evolving tracks on Chinese ancient physicians throughout various periods, by selecting ancient medical literatures with representativeness from Traditional Chinese Medicine; interpreting, analyzing and sorting out the account and expounding on the characteristics regarding pulse conditions of the moderate pulse and their clinical meanings.1.2Research on contemporary documentsThis study used "the moderate pulse" as a key word, systematically searched and sorted out the description and the application of the moderate pulse in the contemporary "Diagnostics of the Traditional Chinese Medicine" and a great deal of teaching materials on internal medicine, surgical department, gynaecology and etc. in Traditional Chinese Medicine, and Guidelines for Diagnosis and Treatment of Common Departmental Diseases in Traditional Chinese Medicine; then analyzed and put in order the current recognition of the moderate pulse in contemporary Traditional Chinese Medicine; summarized the existing issues and found out relations and discrepancies between documents from the contemporary and the ancient.2. Interviews and surveys on clinical physicians of Traditional Chinese Medicine, concerning the characteristics of pulse conditions on the moderate pulse:On the basis of the divergence in the recognition of the moderate pulse nowadays, this study drew up an outline for interviews, applying open-ended questions, through interviews on clinical experts of Traditional Chinese Medicine with various specialties in small sample, looked into the recognition and application on the features of pulse conditions of the moderate pulse among the contemporary experts, summed up amd analyzed the discrepancies between the actual clinical application and teaching materials/monographs on the moderate pulse.Results1. The study of documents on the characteristics of pulse conditions of the moderate pulse and their clinical meanings1.1Research on documents of ancient timesDuring the dynasties of Qin and Han:Although the term of "the moderate pulse" existed then, but there was not a specifie article written, nor any description on its features of pulse conditions.The study then laid special emphasis on its clinical meanings.The physicians stood for the combination of pulse and syndrome, and the synthesis of the four diagnostic methods (the integration and overall analysis of the inspection, auscultation and olfaetion, inqury and palpation),and determined the indications and prognoses accordingly.Concerning the connotations of the moderate pulse, in the light of meaning analyses on related documents, there were many implications, including:gentle or mild, pulse with stomach-qi;"indulgently moderate, lax," wind-cold attacks the exterior and dampness tends to damage the spleen were the indications. Or,it was not some sort of pathological pulse, and the moderate pulse was just applied as an adjective to explain some pulse conditions which had the characteristics of slow rate.In the periods of three kingdoms,two Jins and Northern Southern dynasties Sphygmology diagnostics became a specialty, and the "Mai Jing"(the Pulse Classic) was a product of representativeness. It was the first time that the features of pulse conditions on the moderate pulse were described in the book, i.e.,"the moderate pulse was slow back and forth, slightly faster than the slow pulse," and viewed the characteristics of the moderate pulse as "slow pulse rate." On the aspect of clinical indications, the moderate pulse itself was deemed as "deficiency, wind, cold and dampness;" indications were different in line with various concurrent pulses along with the moderate pulse.Tang and Song period:The implications on the moderate pulse were progressed, and the existing divergence on recognition was obvious, i.e., after all, was the moderate pulse the normal pulse or a pathological pulse? In case of a pathological pulse, what does the word "moderate" describe? What is the number of beats or emphasizing on pulse conformation? Or both? Some doctors considered that "the moderate pulse" was "the normal pulse." and "moderate" meant "gentle or mild;" some other physicians held that "the moderate pulse" had the features of "floating,""softness." and "slight delay." The syndrome of wind, deficiency, cold, dampness and internal heat could be observed in the moderate pulse and its concurrent pulses.Jin-Yuan period:The number of beats for the moderate pulse was clarified as "four beats in one cycle of respiration." and its pulse conformation possessed the feature of laxity and it was not tense. As for the clinical meanings, there were two types of "moderation"-the moderation of "gentleness" and "insufficiency." The moderation of "gentleness" was the normal pulse, and which is regular; the moderation of "insufficiency" was the pathological pulse, the indications could be wind, deficiency, bi-arthralgia. weakness, pain and etc. Strictly speaking, this kind of recognition has its logical confusion, it has made enormous impact to the later generations, and it has been applied continuously to this day.The Ming-Qing dynasty:The same cognition from Jin-Yuan period was continued, major development and changes did not happen. Doctors still stuck to each one’s own argument on knowledge of the moderate pulse. In the respect of features on pulse conditions, some pointed out that the moderate pulse was contrary to the tense pulse on their pulse conformations, while it was similar to the slow pulse on pulse rate:some considered that a pulse could be called as the moderate pulse when provided with the features of calm,gentleness and mildness. In clinical indications, some held that it was the normal pulse when only the moderate pulse showed up, and it was a pathological pulse while concurrent pulse(s) coexisted with the moderate pulse; some advocated that the moderate pulse was a pathological pulse at first, and there was no distinction between the physiological and the pathological.1.2Research on contemporary documentsIn "Diagnostics of Traditional Chinese Medicine"(the teaching materials), the moderate pulse is defined as pulse of the normal as well as the pathological, this is to substitute some concepts for others surreptitiously. Strictly speaking,"the moderate pulse" should be put in the category of the pathological pulse, it is a compound pulse constituted by two factors; it could be described as "four beats in one cycle of respiration; moderate, loose, weak and lax." The clinical indications are dampness and the weakness of the spleen and stomach. Likewise,"slow moderate.""lax moderate,""indulgently moderate" and etc. are borrowed from the multiple meanings of "moderate" itself, when the word "moderate" is applied to describe pulse conditions in clinical teaching materials. Notwithstanding, these are not the strict meanings for the moderate pulse. Thus, the connotation for "the moderate pulse" should be redefined. When "moderate" means "slow," it could be combined with "the slow pulse;" when "moderate" represents "slackly indulgent." it could be named "the lax pulse." And it could be called "the moderate pulse" when the two features, the pulse rate of four beats in one cycle of respiration,sloth back and forth and the pulse force of laxity and slack, are provided simultaneously.2. Interviews and surveys on Traditional Chinese Medicine clinical doctors/expertsOn the characteristics of pulse conditions in the moderate pulse, some experts deem that "the moderate pulse’" is a pulse of single factor,73%of them hold that the feature is decrease in pulse rate, i.e., slightly faster than the slow pulse but slower than the normal pulse. A few consider that the feature is "slack back and forth." the pulse rate is not necessarily decreasing, but "languid back and forth."The two circumstances,mentioned above, are frequently written as "slow" in the clinical. Some other experts hold that "the moderate pulse" possesses many essential elements.92%of them point out that its features include two aspects:slowness in pulse rate and laxity in pulse conformation.Concerning the clinical meanings of "the moderate pulse," when it possesses only one characteristic of "slowness." it is often observed in the syndrome of cold (defilcient cold and excessive cold), deficieney syndrome, too slow on aperture heartbeat and etc. When it has only one element of "laxity" or "sloth back and forth,"there is no particularity with the indications. In case of the moderate pulse is formed by "sluggishness" along with other features of pulse conformation,usually the indications are syndrome of dampness and deficiency; including qi-dellcicncy,yang-dellciency,qi and blood deficiency and spleen deficiency. If the pulse condition is gentle but vigorous, and pulse rate is relatively slower (60times per minute), it demonstrates that these are stomach-qi and spirit-qi, these could be seen in strong and healthy people.It is thus evident that the discrepancies on the recognition of the moderat pulse have existed all the way from ancient to modern times. The conclusion, on the study of the indications in features of pulse conditions with the moderate pulse, has not been unified as well. There are many kinds of implications in the word of "moderate," of them, the connotation on "laxity" and "postponement" has been the source of causing the implications of the moderate pulse and its dispute on indications.DiscussionsIt has been long-standing on the existing discrepancies in the cognition of the moderate pulse. It has not arrived in unification, all along, on the study conclusion with regard to the features of pulse conditions in the moderate pulse and its indications. Of them, the dispute of the characteristics of pulse conditions on the moderate pulse has encircled mainly at the word "moderate." Does "moderate" exactly describe pulse rate or pulse conformation? Or, it has both at the same time;yet, it might posses other connotations. As to the clinical meanings of the moderate pulse, there are approximately three kinds of cognition:1. the moderate pulse is deemed as pathological pulse;2. it is held as the normal pulse and it does not have any meanings in pathology;3. it is considered that there are two kinds of moderate pulse-normal and pathological innature, it is normal pulse sometimes and pathological now and then. Evidently, there are issues of ambiguous concepts and confused logic, when we look at the problems today. Search to the bottom, it is rational to say that the issues have been caused from the multiple meanings of the word "moderate.""Moderate" has diversified implications; among them,"laxity or slackness" and "delay or postponement," the two connotations are the major reasons which have created the controversy on moderate pulse.Conclusions1. The confusion on the description and recognition of the moderate pulse, nowadays, is pertinent to the one word "moderate." however, with multiple meanings.2. The moderate pulse contains the implications of "the normal pulse":"not fast nor slow, calm and gentle." no longer will "the moderate pulse" be named; the connotation of "slowness" in the moderate pulse could be incorporated into "the slow pulse,"and be named "the slow pulse" or "the slow moderate pulse;" the meanings of "laxity" and "slackness" in the moderate pulse could be replaced by "the lax pulse," and be in contrast with "the tense pulse." The notion of "the moderate pulse" would not be used any more; perhaps it could be called "the moderate pulse" when the pulse possesses the two implications of "slowness" and "laxity, slackness.’3. Limited by personal level of profession and materials that could be taken into hands, critique and comments on the above conclusions/suggestions are greatly appreciated, and corrections could be made.Points of Innovation1. This study is unprecedented. It has been done by systematically analyzing documents from ancient times as well as the contemporary; visitations of experts; comprehensive analyses--sorting out and putting in a nutshell on knowledge of the experts (antient and contemporary)-regarding the origin, development and trajectory on features with pulse conditions of "the moderate pulse.’2. Innovatively put forward the coming off of the three implications in the present moderate pulse and include the connotations to the normal pulse, the slow pulse (or the slow moderate pulse) and "the lax pulse" respectively. And terminate the concept of "the moderate pulse.’... |
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