This has set me thinking about my own approach to pulse-taking, best summed up, I feel, by something I said to those attending my last SOFEA clinical seminar. In effect I told them, a bit tongue in cheek, to “forget the pulses”. This is something I often find myself saying to practitioners in an attempt to remove some of the unnecessary burden they feel when trying to interpret pulses. I suggest, instead, that they should concentrate on looking at the patient as a whole whose pulses are only one of many manifestations of the elements. I always labour the point that the extreme subtlety of what these 12 pulses are telling us makes their interpretation an art which has to be honed over many years, and like all arts is a skill that is never perfected.
My approach is based upon what I was taught as an undergraduate at
The famous 27 pulse qualities were only mentioned once by JR, almost as an aside, when, as part of what was apparently considered necessary to complete the syllabus, he raced through the different pulse qualities in about 15 minutes with obvious disinterest, ending with telling us, “and that’s all you need to know about the 27 pulses qualities”. This appeared to be a doorway through which he did not think it necessary for us to pass.
Another occasion with JR had a much more profound effect on me. I told him at one point that sometimes I felt that I couldn’t interpret anything my fingers were trying to tell me. He said, “I know what you mean. I will feel the same, and then perhaps a month later I will realise that my pulse-taking has moved to another level.”
These words of his hover over my fingers as I take pulses even now. I never wait too long to try and interpret what I feel, and can even find myself talking as I take them, almost as if I want to allow my mind to do its thinking through words so that it sets my spirit free just to feel. And then I try to add what I am feeling to what my other senses are telling me to help me interpret the signals the patients is sending me through everything they do or say.
What worries me about approaches to pulse-taking is that pulses represent one of the few aspects of five element practice where we ask for a physical response from a patient’s body. All the other forms of diagnosis are much more ephemeral. We can’t physically touch a smell, a sound of voice, a colour or an emotion, but we can certainly physically touch a hand to feel a pulse. And the physical appears to provide a reassuring refuge to which we can retreat if our other senses confuse us and prove too elusive. I have decided that this is the reason why all novice practitioners (and quite a few experienced practitioners, too!) immediately reach for the hands of the patient lying there on the couch, rather than paying attention to the patient as a whole, as though needing to anchor themselves immediately in the physical. Sometimes I feel, rather wickedly, that this is a bit like a drowning person grasping a lifebuoy.
Except in the case of blocks, where I always try to add other information to what my fingers may be telling me, pulses play an almost subsidiary role compared with what I learn from the total picture presented by the patient. So Peter and I, both trained in the same school, but he, unlike me, having received much more extensive training in other disciplines, have arrived at somewhat different points on the scale of the importance we attribute to what our fingers can tell us. I am nonetheless fascinated by all those other approaches his new book covers, but which I know I may only ever appreciate in theory, not in practice.
(See also my other two blogs on pulse-taking: The mystery of pulses, 22 October 2010, and Using our two hands, 24 February 2012)