Traditional chinese medicine and tinnitus zumbido,ear plugs for blocking noise floor,random ringing in right ear burning - PDF Review

Author: admin, 10.03.2014. Category: Tinnitus Causes And Cures

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The changing setting in which Chinese medicine is practiced in modern versus ancient times, especially with the advent of advanced technological medical diagnostics, has raised questions as to the value of pulse diagnosis. I've been practicing for over five years now and have a busy practice; but, I'm totally disheartened about my abilities.
This practitioner has recognized something that many others, who feel more confident despite limited training, may ignore: there is a great potential to simply "fantasize" the diagnostic signs, that is, to read into it something that is not really present. The information presented below is aimed at examining the traditional and modern roles of pulse diagnosis, the techniques for taking the pulse, the interpretation of various pulse forms, and some of the controversies that exist regarding the use of pulse diagnosis. Pulse diagnosis is one of the original set of four diagnostic methods that are described as an essential part of traditional Chinese medical practice (1).
All of these diagnostic methods yield information that helps to determine the syndrome and constitution to be treated.
Pulse diagnosis is mentioned in ancient texts, such as the Huangdi Neijing and the Huangdi Neijing of the Han Dynasty period, but with only sporadic mention of various pulse forms and their meaning. A yin pulse that shows no stomach qi is called the pulse of zhenzang [decaying pulse] and the prognosis is usually death. A more complete prognosis involves coupling the information about the pulse with the examination of the facial color and the "spirit" expressed by the facial expressions (especially the eyes). In the Huangdi Neijing (3), the pulse is mentioned briefly and simply among a list of symptoms that would indicate a particular disease stage or category; thus, for the taiyang disease, the pulse is floating, for a yangming disease, the pulse is large, and for the jueyin disease, the pulse is feeble. The presentation of diagnostic information in these works of Zhang Zhongjing confirms the importance of inquiry, since it is by this means that one learns the essential features described throughout most of the text, such as location of pain, duration of disease, and other factors that determine the selection of herbs (thirst, mental conditions, urination, etc.). The concern is about incomplete and careless diagnosis, particularly where the pulse is the primary diagnostic method (omitting or minimizing the others), and failure to carry out the full pulse taking (front and rear pulses). The subject of pulse diagnosis was first tackled in an organized manner by Wang Shuhe, who lived during the 3rd century A.D. In the Mai Jing, a broad spectrum of applications for pulse diagnosis is delineated, including etiology of disease, nature of the disease, and prognosis. If its emerging and submerging are equal, this is a normal state; if its submerging is twice as long as its emerging, this is shaoyin.
As to prognosis, an example with great specificity is: "If, on the seventh or eighth day, a febrile disease exhibits a pulse which is not grasping-like but beating rapidly at a constant pace, there ought to arise a disease of loss of voice. After the production of the Mai Jing, many different conceptions of pulse diagnosis arose and led to a great deal of confusion about interpreting what was being felt by the physician. Those experts who discussed the pulse through the ages have all contradicted one another, and they all differed in what they considered right and wrong. In other words, the classic texts of the Han Dynasty have the basic doctrines of importance, and they must all be studied in order for the Mai Jing to be fully meaningful.
The aim of pulse diagnosis, like the other methods of diagnosis, has always been to obtain useful information about what goes on inside the body, what has caused disease, what might be done to rectify the problem, and what are the chances of success.
In his book reviewing pulse diagnosis (5), Bob Flaws emphasizes the importance of learning the basic pulse categories in order for pulse diagnosis to be conducted effectively.
In my experience, the secret of Chinese pulse examination is exactly this: One cannot feel a pulse image unless one can consciously and accurately state the standard, textbook definition of that pulse image. This, precisely, is the critical issue: there is no point in attempting practical training in pulse diagnosis unless all pertinent theory and, more important, the complete iconography [set of image categories] of the pulse has previously been absorbed intellectually. Chinese medical texts do not describe what the practitioner experience is (or should be) during pulse diagnosis; this is left to be passed on from accomplished practitioner to student. The most standard inconography involves from 24-28 different pulse forms, depending on the recitation (sometimes a pulse type is subdivided into two; sometimes a complex pulse type is not included), though simplified sets are often given in less formal presentations. In a recent article describing the standard pulse categories by terminology expert Xie Zhufan (7), 26 basic pulse types were outlined and given updated English language interpretations (two of the types have the same Chinese name but different descriptions).
In the table, the English translation term is given first; in a few cases, alternative English names are given for the same traditional category indicated by a single Chinese term (given in pinyin). An irregular pulse, hardly perceptible, occurring in critical cases showing exhaustion of qi.
These are cases where the patient is critically ill, perhaps near death; such patients are normally hospitalized (or sent home to die) and their diagnosis is usually well-established.
A slow pulse pausing at regular intervals, often occurring in exhaustion of zangfu organs, severe trauma, or being seized by terror.
As with the scattered pulse, this pulse type is usually only seen in cases where the person is hospitalized or otherwise in an advanced disease stage.


A pulse feeling hasty and swift, 120-140 beats per minute, often occurring in severe acute febrile disease or consumptive conditions.
This pulse is so rapid (twice the normal speed) that it is easily detected; the acute febrile disease involves an easily measured high temperature and is usually subject of pathogen testing.
A pulse that feels floating, large, soft, and hollow, like a scallion stalk, occurring in massive loss of blood. A pulse beating like dashing waves with forceful rising and gradual decline, indicating excessive heat.
Excess heat syndromes are rarely difficult to detect, so this pulse type adds little information.
A pulse that can only be felt by pressing to the bone, located even deeper than the sinking pulse, often appearing in syncope or severe pain. This pulse is quite extreme, in that one can barely detect it except by applying deep pressure; it gives the sense that the pulse is hidden in the muscles. A slow pulse pausing at irregular intervals, often occurring in stagnation of qi and blood. Qi and blood stasis represents a traditional diagnostic category that does not have a direct correlation with modern diagnostics. A rapid pulse with irregular intermittence, often due to excessive heat with stagnation of qi and blood, or retention of phlegm or undigested food. Particularly in young people, the pulse is felt rather easily across all three finger positions, as is characteristic of the long pulse. The short pulse seems to deteriorate from the central pulse position towards the two adjacent pulse positions. A pulse felt like a fine thread, but always distinctly perceptible, indicating deficiency of qi and blood or other deficiency states. Although the deficiency can be easily detected by other means, some patients can show an artificially robust exterior appearance, while having notable deficiency. A pulse coming and going choppily with small, fine, slow, joggling tempo like scraping bamboo with a knife, indicating sluggish blood circulation due to deficiency of blood or stagnation of qi and blood. This has a more irregular pattern than the knotted pulse that also shows stagnation of qi and blood.
A pulse like beads rolling on a plate, found in patients with phlegm-damp or food stagnation, and also in normal persons. While use of the pulse to indicate pregnancy is no longer of value (as more reliable tests are readily available), and while this pulse, like the long pulse is often normal (occurring especially in persons who are somewhat heavy), it is a good confirmation of a diagnosis of phlegm-damp accumulation. The pulse has a softness or looseness that is due to the weakness of the qi and the obstructing effect of dampness. This is similar to the loose pulse, above (and the Chinese name is the same), except that it has a better tension, showing that the qi is adequate. A pulse that feels straight and long, like a musical instrument string, usually occurring in liver and gallbladder disorders or severe pain. A pulse felt vigorously and forcefully on both light and heavy pressure, implying excessiveness.
This pulse gives relatively little information other than that the condition is one of excess; one must further determine the nature of the excess in order to select a therapeutic strategy. A superficial, thin, and soft pulse which can be felt on light touch like a thread floating on water, but grows faint on hard pressuring, indicating deficiency conditions or damp retention. A pulse feeling feeble and void, indicating deficiency of qi and blood or impairment of body fluid.
A pulse with increased frequency (more than 90 beats per minute), usually indicating the presence of heat. The rapid pulse is quite a bit more rapid than a normal pulse, and usually occurs only when there is a serious illness and mainly when there is a fever. A pulse with reduced frequency (less than 60 beats per minute), usually indicating endogenous cold. A slow pulse may also indicate a person at rest who normally has a high level of physical activity, so must be interpreted in light of other diagnostic information. A pulse that can only be felt by pressing hard, usually indicating that the illness is located deep in the interior of the body.
The circulation of qi and blood from the internal viscera to the surface is weak; it is usually confined to the interior as part of the body's attempt to deal with a serious disorder threatening the viscera. A pulse that is palpable by light touch and grows faint on hard pressure, usually indicating that the illness is in the exterior portion of the body. The circulation of qi and blood is focused in the body's surface to deal with an external pathogenic agent. Gao De, a diagnosis specialist at the Academy of Traditional Chinese Medicine, cautioned that pulse taking has become obscured by a multiplication of pulse categories (13).
The types of pulses that have been listed are too numerous and great disparity exists in the ways in which they have been recorded. The difference between some categories is not so sharp, such as that between overflowing and large, thready and small, rapid and fast (hurried), and deep and hidden.
Single-feature pulse conditions are already numerous enough and the additional nomenclature adds even more names which have little clinical significance but add to the difficulties for beginners.
Mastery of these 16 basic single-feature pulse conditions, together with their possible combinations and their indications, is sufficient to meet the needs in clinical differentiation of syndromes.
In the text Chinese Acupuncture and Moxibustion (15), there is a listing of 17 pulses to know, all of which are said to represent the abnormal conditions. Similarly, in the book Chinese Herbal Science (17) by Hong-yen Hsu, the pulses of importance are limited in number.
The general implication of the literature on pulse is that there are about two dozen pulse types to be learned in detail, but that there are only a few of them (sometimes grouping similar pulses together) that are critical for the everyday utilization of this diagnostic technique used in combination with other methods of diagnosis.
Despite the availability of more than one site for pulse taking, standard Chinese medical diagnosis almost always is limited to the wrist pulse. The general sensation of the pulse at the two wrists overall: instead of distinguishing each pulse position (cun, guan, chi), the quality of the pulse is categorized generally, as felt under the three fingers. Feeling the pulse at each of the individual positions on the wrists, to assess the condition of each of the internal organs.
The interpretation of which pulse position corresponds to which organ has changed over time; the assignments commonly relied upon today are attributed to Li Shizhen (1518-1593), who is most famous as the author of the Bencao Gangmu. The various outcomes of the pulse diagnostics are outlined succinctly and in table form in Ted Kaptchuk's book The Web that Has No Weaver (14). The patient must be relaxed and have not undertaken any vigorous activity for some time prior to the pulse taking. The patient's arm, wrist, and hand must be relaxed, with the hand supported on a small pillow or other object; the hand is below the heart, at about the location of the navel as the person sits. The placement of the physician's fingers are at the cun ("inch"), guan ("bar"), and chi ("cubit") positions. The physician, through training and experience, applies the appropriate amount of pressure. Adequate duration of pulse diagnosis is allowed to assure that the pulse description holds true over many pulsations, and that both arms are checked in order to give a full evaluation. A doctor must be aware of the fact that as numerous changes can take place within a man's body under natural physical condition, so can variations of normal pulse condition.


In addition to these factors based on traditional and natural considerations, one must take into account new factors that may influence the pulse, such as use of drugs, including nicotine products, pharmaceutical drugs, and illegal drugs.
The numerous factors to be taken into consideration and the associated difficulties in interpretation mean that pulse taking in the modern setting is rarely as informative as it is depicted in the historical texts.
During the development of Chinese medicine, there appears to have arisen, from time to time, an understanding that a well-trained physician was able to make a diagnosis almost entirely by pulse taking, while asking virtually no questions of the patient. The utility of pulse diagnosis may be more properly viewed as belonging to the realm of confirming a diagnosis attained by other means, including modern medical testing, or implying that something is missing from the diagnosis when the pulse does not agree, setting off a series of questions or investigations for additional information. This Western ambivalence toward and pervasive lack of mastery of the pulse examination is, I believe, exacerbated by a somewhat similar attitude towards pulse examination current in the People's Republic of China at least in the 1980's.
Indeed, the set of pulses that Flaws mentioned hearing repeatedly in China is the most basic set that must be learned and is similar to what was described above by several authors as the key categories. In his book, Flaws goes on to argue that the importance of the pulse in modern practice lies with the complexity of chronic conditions suffered by many patients who turn to acupuncture in the West. According to Chinese Acupuncture and Moxibustion: "As the process of disease is complex, the abnormal pulses do not often appear in their pure form, the combination of two pulses or more is often present.
Clearly, the role of pulse within the full framework of diagnosis will remain an area of some contention.
In modern medicine, the traditional style of pulse diagnosis, which was also practiced in a slightly different form in Western medicine until the 19th century, is replaced by a number of other tests. Modern medicine has numerous other kinds of tests, including blood tests, urine tests, and a variety of scans and biopsies, that reveal a tremendous amount of information about what goes on inside the body, so as to produce a diagnosis. While patients in China have come to rely on the traditional medical practitioners to simply carry out their diagnosis in silence and prescribe a therapy to be taken without question, modern patients in the West prefer to talk about their diseases. The complex condition of many modern patients may require one to rely heavily on modern medical diagnostics as a primary resource, making it the essential fifth diagnostic method for the practitioner of Chinese medicine. The question arises: does the old system of pulse diagnosis still have a value to practitioners of traditional medicine given the wealth of information derived from modern tests? Many acupuncturists trained in the West have pursued a type of pulse diagnosis that is not described in the traditional Chinese literature. It would not be surprising that acupuncture would alter the pulse sensation detected in some or even most individuals (see: An introduction to acupuncture and how it works). While this type of diagnosis may be valuable for its primary purpose as a means of confirming the desired reaction from acupuncture therapy, it is not the same as the pulse taking method that is used for basic diagnosis and should not be assumed to replace the traditional style and application of pulse diagnosis.
One of the serious objections to reliance on pulse diagnosis is that the pulse form determined by a practitioner is very subjective. Imitating the pulse actually means that the abstract descriptions and images [of the traditional system] are changed to specific figures signifying digital senses directly felt and stored. Chinese researchers have pursued the question of how often certain pulse types are found, particularly with frequently occurring serious diseases, such as cancer and hepatitis.
Studies indicate that wiry, slippery, and rapid pulse, or simply wiry and rapid pulse, often denotes exacerbation of the illness [cancer]. In a study of advanced hepatitis patients with cirrhosis or liver cancer carried out in Taiwan, it was reported that most of the patients had a weak pulse on the left wrist at the cun and chi positions, compared to normal subjects (22). In a broad evaluation conducted in Hong Kong, it was reported that specific pulse categories are more commonly found with the initial stage of illness, versus more developed and advanced stages of an illness (23). Very abnormal pulses (critical illness): tremulous, running, knotted, intermittent, tympanic, scattered, deep-sited, replete, feeble, no pulse. Pulse diagnosis is one method of determining the internal conditions of patients with the aim of deciding upon a therapeutic regimen. Maoshing Ni, The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen with Commentary, 1995 Shambhala, Boston, MA. Porkert, M, The Essentials of Chinese Diagnostics, 1983 Chinese Medicine Publications, Zurich. Xie Zhufan and Huang Xiaokai (editors), Dictionary of Traditional Chinese Medicine, 1984 Commercial Press, Hong Kong. Hsu HY and Wang SY (translators), Chin Kuei Yao Lueh, 1983 Oriental Healing Arts Institute, Long Beach, CA.
Unschuld PU, Forgotten Traditions of Ancient Chinese Medicine, 1990 Paradigm Publications, Brookline, MA.
O'Connor J and Bensky D (translators and editors), Acupuncture: A Comprehensive Text, 1981 Eastland Press, Seattle, WA. Editorial Committee, International Conference on Traditional Chinese Medicine and Pharmacology Proceedings, 1987 China Academic Publishers, Beijing; 1087-1099.
Anonymous, Essentials of Chinese Acupuncture, 1980 Beijing Foreign Languages Press, Beijing. Huang Huibo, New theory on pulse study, in International Congress on Traditional Medicine Abstracts, 2000 Academic Bureau of the Congress, Beijing. It is one of the oldest continuously practiced medical systems in the world with a written history dating over 2,500 years.
Many Chinese herbal formulas serve to strengthen the body and its many functional systems to prevent illness. Our clinic has great experience in the combined use of acupuncture and Chinese herbal medicine to achieve the best clinical results. We do not use any medicines containing endangered or illegally traded wildlife ingredients. Their use requires professional knowledge and thus should be prescribed by practitioners qualified in Chinese Herbal Medicine. Furthermore, they will advise you when it is appropriate to change or discontinue your Chinese herbal medication as part of your follow-up consultations. The physician is calm and able to concentrate; the physician's hand that is performing the diagnosis is also in a relaxed position. This is not a matter of the traditional practitioner deciding that this is the desired route, but a reflection of the extent to which modern lifestyle and modern medicine imposes itself on people who might have an interest in a traditional and natural approach. He indicated that, ideally, the pulse would return to normal or markedly calm down after the needle insertion and this improved pulse condition would continue until the needle was withdrawn; the pulse would stay calm at least for a time afterward. He describes his observation as a "discovery," therefore not something belonging to the Chinese tradition and not something that he was aware was being relied upon by other acupuncturists at the time. Harm can occur when any medicine is taken without professional advice, or when individual herbal ingredients are supplied in inappropriate and dangerous dosages.
Beware of medicinal products you can order from overseas which may not be regulated or safe. There is some question, however, as to how this seasonal influence might be modified by modern living habits, including rising and going to bed out of synch with the sunrise and sunset, use of central heating and air conditioning, and eating foods out of season.
He has assumed, perhaps correctly, that the softening and relaxing effect described in this text applies to the immediate change in the described pulse, as opposed to merely suggesting a change in the patient's overall tense condition. He suggests, might help the practitioner and patient determine the likelihood of success after only a couple of sessions.




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