In a comment on my sister blog on five element treatments, I was asked by Sean to include pulse pictures with my treatments. I made a conscious decision not to do so for various reasons, some of which I am sure will raise eyebrows (but then a lot of what I write probably raises more eyebrows than I am aware of!). To do so, I must place pulse-taking in a five element context, and here there will inevitably be differences with the purpose and methods of pulse-taking for other systems of acupuncture.
We take pulses for the following main reasons:
At the start of treatment to assess the overall strength or weakness of a patient’s energy, and to gauge the relative balance of the elements and their officials one to another;
During and at the end of treatment: to assess change (but there are some major provisos here which I will discuss).
It is important to be aware from the start exactly what a pulse picture does not tell us. It does not tell us what the patient’s guardian element (CF) is, sadly, some of us may think, for perhaps this would make our work easier. What it can do is indicate that treatment directed at one element has changed the balance of energy, but not whether this element is the guardian element.
We take a pulse reading at the start of treatment, at various points during treatment if we are looking for some change which will demand further treatment, such as an Entry/Exit block, and at the end of treatment. We have a blessedly simple form of pulse notation to do this, compared with the 27 notional pulses of other systems. We assess whether the energy of one element and its officials is in a state of (relative) balance, which we note as a check pulse (a tick), whether it is depleted (a minus pulses) or whether it is in excess (a plus pulse). We assess 12 pulses, two for each of the five elements, plus two further for the two Fire functions of Heart Protector (Pericardium) and Three Heater. In each case we feel the pulses at two depths, with all the 6 yang pulses at the superficial level and all the 6 yin at the deeper level.
It is rare for there to be sufficient discrepancy between the yin and yang pulses of any particular element for us to need to correct this (by taking from the relatively stronger and giving to the relatively weaker using the junction (luo) point), but it does happen. So, for all general purposes, we treat the two officials of an element as one, and usually, but not always, treat both yin and yang aspects of an element at any treatment.
This sets the scene for our pulse-taking. How then do we assess change? The major proviso here is that energy does not necessarily shift quickly after needling. It can change so markedly that our pulse reading picks it up, but it may not if change is slower and less dramatic. It can take hours, if not days, for the elements to show any improvement, and this lapse in time will be reflected in the pulses. To rely on perceiving a pulse change as evidence of good treatment is therefore not necessarily an accurate way of doing things, and to interpret no change in pulses as a sign of inadequate treatment is just as meaningless.
And this is where we need to learn to move away from a reliance on what we think the pulses are telling us to increased reliance on our observation of possible change in the patient. Does the patient look happier, quieter, pinker, less white, talk less, talk more? All these are, I believe, more reliable indicators of positive changes than any changes picked up on the pulses. And since energy continues to change long after the patient has left us, and is always completely different when they come back the next time, there seems little point in spending too much time on writing down a final pulse picture, which only gives what will be a temporary snapshot of energy in process of continuous change.
So my advice to all those struggling to feel, let alone interpret, pulses has always been to avoid over-reliance on something which is so ephemeral and delicate. Instead, use as many other powers of observation to interpret what is going on with a patient’s energy. For example, does my patient look as if they are absolutely desperate (Husband/Wife imbalance, perhaps), even if I can’t feel the left pulses as weaker than the right? Do they rub their eyes or ears, even if I can’t feel sufficient discrepancy between the pulses of SI and GB to tell me absolutely that there is an Entry/Exit block there? These are the kinds of aids I use to round out my pulse reading.
We should always remember that our fingers may be clumsy instruments for interpreting the incredibly subtle manifestations of body and soul which pulses represent
So, Sean, I hope this explains why I don’t include pulse pictures.