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The pulse in different medical traditions

Riva-Rocci-type sphymomanomter, England, 1905

Riva-Rocci-type sphymomanomter, England, 1905

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Everyone has a pulse, right? Not exactly. Feeling or  measuring a patient’s pulse is a key diagnostic method in most medical traditions. However, patients’ pulses are interpreted very differently across traditions. This means it is not always clear there is any one thing called ‘the pulse’. Different traditions look for different things: Traditional Chinese Medicine distinguishes 12 basic pulses, six on each wrist, each linked to a different organ or organs; Ayurvedic practitioners interpret the rhythmic pattern of a patient’s pulse as an indication of the balance of the three doshas (basic energy types); biomedicine links the pulse directly to the heart, seeing the beats as an effect of blood circulation through the veins and arteries.

Ancient Egyptians observed the pulse at different locations of the body. They believed ‘the heart speaks out of every limb’. Ancient Greek physicians such as Herophilus observed four characteristics of the pulse: size, frequency, strength and rhythm. Herophilus’s student Galen, and generations of medieval physicians who studied Galen’s writings, questioned what terms such as ‘size’ meant under the fingertips. They also debated how to teach students to feel subtle variations in ‘rhythm’ and ‘frequency’. In 1710 an English physician invented a ‘pulse-watch’ that ran for one minute. This gave a rough way to count pulse rate.

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A different tradition of pulse diagnosis developed in ancient China. It was already discussed here during the Han Dynasty (206 BCE - 220 CE) in the Book of the Yellow Emperor (Nei Ching). Influential 16th-century physician Li Shi-Zhen (Li Shi Chen, 1518-93) published a book on pulse studies which is still used in TCM practice. His description of pulse types and their interpretation is now supplemented in TCM by modern technologies such as electrocardiogram readings.

 Ayurvedic medicine interprets the pulse as a sign of the condition of the soul. A Sanskrit rule states: ‘The learned physician should read the happiness and misery of the body by feeling the pulse at the root of the thumb which stands as the witness of the soul.’

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Islamic medicine, or Unani Tibb, adopted elements of the Greek, Ayurvedic and Chinese traditions. However, it developed them differently. Central figures in Arabic medicine such as al-Razi and Ibn Sina investigated how the pulse related to disease. One story claims Ibn Sina even used the pulse as a sort of lie detector. He questioned the sultan’s wife while feeling her wrist; from her pulse agitations he discovered she was secretly lovesick over someone other than her husband. Similar stories of the use of pulse reading for medical sleuthing were told about other famous doctors from different traditions, including Greek physician Erasistratus.

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Feeling and interpreting the pulse requires huge sensitivity and skill. Some Greek and medieval doctors studied music to improve their abilities. The skill of Arabic doctors at reading the patient’s pulse was illustrated in stories. One tells of a famous physician who claimed he did not even have to touch the patient. Instead he felt the vibrations of string tied around the patient’s pulse. A powerful ruler tested him, tying string to the wrist of a cow hidden behind a curtain. The unfazed physician announced his diagnosis: ‘All this creature needs is grass.’

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The pulse is still one of the most important diagnostic clues for modern practitioners of TCM, Unani Tibb and Ayurveda. They have elaborate classifications of different pulses. However, biomedicine has streamlined pulse classification to quantify the pulse and pulse rate. It uses instruments such as the sphygmograph and ECG. Biomedicine views blood pressure as a more important diagnostic clue than the pulse. Practitioners from alternative traditions argue this neglect of pulse diagnosis is one of biomedicine’s weaknesses.

Bibliography

Li Shi-zhen, The Lakeside Master’s Study of the Pulse, trans. B Flaws (Boulder, CO: Blue Poppy Press, 1998)

S Kuriyama, The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine (New York: Zone Books, 2002)

R B Amber and A M Babey-Brooke, The Pulse in Occident and Orient - Its Philosophy and Practice in India, China, Iran, and the West (New York: Santa Barbara Press, 1966)

A B Davis, Medicine and Its Technology: An Introduction to the History of Medical Instrumentation (Westport, CT: Greenwood Press, 1981)

D Wujastyk (ed. and trans.), The Roots of Ayurveda: Selections from Sanskrit Medical Writings (London: Penguin Classics, 1998)

E Hsu, ‘Towards a science of touch, part I: Chinese pulse diagnostics in early modern Europe’, Anthropology and Medicine, 7/2 (2000), pp 251-68

E Hsu, ‘Tactility and the body in early Chinese medicine’, Science in Context, 18 (2005), pp 7-34

Glossary:

Doshas

The three energies in Ayurveda medicine. When in balance with each other are believed to maintain good health and also determine personality.

Biomedicine

The name given to the medical practice that is based on the sciences of the body, such as physiology (the functioning of the body).

Polygraph

a machine designed to detect and record changes in physiological characteristics, such as a person's pulse and breathing rates, used especially as a lie detector.

Sphygmograph

An instrument used to measure the pulse. It records the strength and rate of a person's pulse. Records are recorded on graph paper.

Sphygmograph

An instrument used to measure the pulse. It records the strength and rate of a person's pulse. Records are recorded on graph paper.