Medical Dialogue
医学会话
Discussion of Pulse Diagnosis
讨论切脉诊断
Jimmy Bell is a doctor of Oriental Medicine in Florida. Donna Vigil is a 64 year-old female patient. She asks Dr. Bell about what he feels in q pulse.
| mrs. vigil: | Dr. Bell, I am curious. Why do you always check my pulse when I see you? |
| dr. bell: | Feeling the pulse is one of four diagnostic methods in Chinese medicine. |
| mrs. vigil: | Can you explain the importance of that to me? |
| dr. bell: | It would take at least a semester of learning and practicing to grasp the basics of pulse diagnosis, but I can talk you through your pulses today. |
| mrs. vigil: | That would be lovely. |
| dr. bell: | You've noticed that I only observe the pulse at your wrists. I could also palpate or feel the carotid pulse in your neck or down here at the anterior tibial pulse, just below your inner ankle. |
| mrs. vigil: | Really? You did not check the pulse in my neck and ankle. |
| dr. bell: | The radial pulse at your wrist, though, is the most practical. I palpate simultaneously three positions on each wrist like this. And I observe through three separate depths: superficial, mid-level and just off the bone. Here I begin my search through the pulses by a light touch at the superficial levels, then I press into the deeper levels. I even move side to side like this to study the pulse. |
| mrs. vigil: | What are you looking for? |
| dr. bell: | A morbidity in the pulse. |
| mrs. vigil: | Oh my! |
| dr. bell: | By morbidity I mean any pathological change in the pulse. By this I mean is it floating, is it replete or vacuous, is it rough or relaxed, does it feel firm, does it dissipate, does it stir as a wind stirs? |
| mrs. vigil: | Oh, you mean that you check many things, not only heart rate? |
| dr. bell: | Yes, you are right. I am aware of each position, its rhythm, its shape, its overall strength and at which level the morbidity presents, not only the heart rate. Shall I continue? |
| mrs. vigil: | Yes, please. |
| dr. bell: | OK. You see where my index fingers are? On your left wrist, this is where I observe the condition of your heart and small intestine. On the right wrist, this is where I feel the condition of your lungs and large intestine. |
| mrs. vigil: | That is very fascinating. |
| dr. bell: | At the tip of each of my middle fingers, I can observe the condition of your liver and gallbladder and here on the right the condition of your spleen and your stomach. At each ring finger, I can feel the condition of your kidney on your left wrist and what we call your "life gate" on your right. |
| mrs. vigil: | So can you tell if someone has hepatitis or kidney failure? |
| dr. bell: | TCM is about recognizing patterns and differentiating between those patterns to determine a relevant treatment strategy. We don't feel disease through pulse; we feel for pathological change in the pulse. |
| mrs. vigil: | Morbidity in the pulse. |
| dr. bell: | That's right. You first came to the clinic three weeks ago for aggravated knee pain. |
| mrs. vigil: | Yes. And it's feeling much better, thank you. |
| dr. bell: | I'm glad to hear that. Before today your pulse was string-like, moderate and sunken, with deficiencies of the kidney. Your pulse told me that this is not just an acute knee injury. The pulse confirmed that the blood and qi dynamic of your body was not functioning as efficiently as it could be. |
| mrs. vigil: | How is it different today? |
| dr. bell: | They are floating and slightly rapid. Do you have a sore throat in addition to your red itchy eyes and runny nose? |
| mrs. vigil: | Just a little irritated from post-nasal drip. You can feel a sore throat in the pulse? |
| dr. bell: | Not exactly, but the floating, slightly rapid quality of your pulse today tells me that your body is struggling against an external pathogenic factor. |
| mrs. vigil: | That's very interesting. |
| dr. bell: | Your pulse today is 88 beats per minute. That is not extremely rapid, and though it is faster than normal for you, it felt weak. Is post-nasal drip a chronic condition for you? |
| mrs. vigil: | I get allergies like this every year. The bad thing is that they are worse every year. It just wears me out. All I want to do is sleep. Can you get rid of my allergies? |
| dr. bell: | I can work with you to strengthen your body. In Chinese medical terminology, I would supplement the dynamic between your lungs and kidneys. When we can correct the morbidity in your pulse and each position is balanced, then your body can properly respond to all outside stimuli more appropriately. |
| mrs. vigil: | I understand most of what you said, and it sounds valuable to me. I'm still amazed that you can learn so much by taking the pulses at my wrists. |
| dr. bell: | It takes a lifetime of study and practice. |
| mrs. vigil: | Thank you for sharing, Dr. Bell. I don't think Fil ever really understand the art or the science of it, but I'm sure glad that you do. |
| dr. bell: | Thank you. Shall we talk about how we're going to get you better? |
| mrs. vigil: | Oh, yes, I'm completely ready to hear that. |