Cute little bird FIVE PHASE PULSE DIAGNOSIS:
The Art of Science Or The Science of Art?
by Andrew Smith MEd BA(Mil) DipAc

This paper is reproduced with permission from the Editor, Pacific Journal of Oriental Medicine.


ABSTRACT

The process of pulse diagnosis as utilised in traditional Chinese medicine was examined in a sample of one hundred patients randomly selected from the author's acupuncture clinic. Patient's symptoms, pulses (as described in traditional Chinese medicine), diagnostic criteria (pertaining to Five Phase acupuncture), acupuncture points selected and patient's comments after each treatment were coded into a numerical format suitable for stepwise multiple regression and cross-tabulation analysis.

The analysis indicated that the interpretation of pulse qualities, from which the treatment protocol was based, predicted the diagnostic criteria when used in accordance with the theories pertaining to acupuncture. Statistically, the selection of acupuncture points could not be predicted from the diagnostic criteria when using pulse diagnosis. Additionally the analysis indicated that the patient's comments after acupuncture were independent of the initial patient symptoms.

More research is needed to more fully understand the process of pulse diagnosis. However the analysis does suggest that pulse diagnosis should be incorporated into acupuncture curricula in both traditional acupuncture courses and medical acupuncture courses.


INTRODUCTION

Traditional acupuncture utilises pulse diagnosis as one of the 'four methods of examination' when establishing information about a patient's signs and symptoms (NH&MRC, 1989; Maciocia, 1991; Kaptchuk, 1983). Within the author's clinic, the subsequent selection of points to treat those symptoms is predominantly based upon the resulting diagnostic criteria taken from the pulses. Ultimately the process of acupuncture used by the author is designed to stimulate the natural healing response of the patient.

The National Health and Medical Research Council (NH&MRC, 1989) suggest that the education and training a practitioner receives is important in insuring the safety of the patients receiving such care.

However debate exists as to whether medical acupuncturists, or acupuncturists versed in the traditional approach, should practise acupuncture (Richardson and Vincent, 1989; Stephen, 1978; Hadley, 1988; Rogers, 1985b; Christie, 1991; Lewith, 1986; Rogers, 1991a). Medical acupuncturists do not learn pulse diagnosis in their courses and generally apply what is termed 'cookbook' acupuncture within their clinic.

It has been suggested that acupuncture practised in this way is generally less efficacious than the more traditional approach (Ng, 1978). The author considers this to be so because there does not appear to be an adequate methodology with medical acupuncture to account for the relationships linking the patient symptoms, the diagnostic criteria, the points selected and the resultant patient comments at the conclusion of the process of acupuncture.

Acupuncture Education

A minimum standard of training has been recommended as being acceptable for non-medical practitioners of acupuncture. The training course for non-medical acupuncturists, formally endorsed by the New South Wales Higher Education Board (NSWHEB) as being acceptable as a Bachelor of Applied Sciences, has pulse diagnosis as a significant component of the acupuncture curricula (Rogers C., 1992).

Acupuncture education in Australia is offered in two forms and to two different groups (NH&MRC, 1989). Courses teach acupuncture as a therapy or acupuncture as a total system of health care, and, the students are either already trained and practising as health care providers or have no previous training or expertise (NH&MRC, 1989). Some courses teach acupuncture to trainees already otherwise trained as health practitioners (NH&MRC, 1989). Acupuncture taught and practised to those medically trained is regarded as an auxiliary or adjunct to the conventional medical techniques utilised by that person.

Other courses purport to teach acupuncture as a complete system of medicine (NH&MRC, 1989). These particular courses offer both basic training over a four year period as an acupuncture therapist. In May 1987, official ratification of accreditation was granted by the Department of Education in New South Wales to Acupuncture Colleges (Australia) for their four year acupuncture training programme, which, at that time, was presented in conjunction with the Institute of Nursing Studies, Sydney College of Advanced Education (Acupuncture Ethics and Standards Organisation Submission to the Minister for Health for the Registration of Acupuncture, 1988).

The emphasis of the course curricula for acupuncture of the University of Technology Sydney, for example, is to teach the philosophies and techniques of acupuncture as taught and practised in the Peoples Republic of China. Moreover the establishment of two university courses of traditional acupuncture is in accordance with the recommendations of the National Health and Medical Research Council (NH&MRC, 1989).

In 1987 the Acupuncture Ethics and Standards Organisation (AESO) were requested by the Peoples Republic of China to apply for membership of the World Federation of Acupuncture/Moxibustion Societies as the representatives of acupuncture in Australia (AESO Submission to the Ministers of Health for the Registration of Acupuncture in Australia, 1988).

Each of the above teaching methodologies, that is, medical compared with traditional acupuncture, differ in the emphasis placed on applying the traditional process of pulse diagnosis as a diagnostic method. The NH&MRC (1989, p.66) suggested that the theoretical concepts behind traditional Chinese acupuncture cannot be sustained scientifically. However Rogers (1991, pp.151-152) suggests that scepticism and/or vested interest among the more influential members of the medical profession inhibit active promotion of acupuncture and such procedures for a number of reasons:

  1. The public perception of professional/scientific authority would be weakened. Competent acupuncture teachers/clinicians would have to be found raising questions as to who would be competent to select/grade them.
  2. Academic undergraduate curricula would have to be re-scheduled to incorporate time for acupuncture at the expense of other course work.
  3. Research teams would have to recruit expert acupuncture specialists and fund acupuncture research in the face of a multi-national, multi-million dollar drug industry which has a powerful influence on funding of orthodox research, sponsorship of drug-related professional seminars/conferences... for cooperative practitioners.
  4. The National Health medical/dental/veterinary hospitals, physiotherapy clinics and the general professions would have to establish acupuncture services.
The above concerns apply equally to veterinary acupuncture which is based primarily on human acupuncture principles (Rogers P., 1991c). The choice of points for particular conditions is very similar to the choice for similar human conditions (Rogers P., 1985a) hence the disagreement surrounding the diagnostic methodology to be used exists whether acupuncture is to be used for humans or animals (Palmer R., 1992).

The author has used pulse diagnosis as the main method of obtaining an indication of the points necessary to treat various conditions in a Primary Health Care setting. The author's use of pulse diagnosis is based upon the Five Phase theories underpinning acupuncture rather than the classic 28 pulse qualities commonly described in acupuncture texts. It is within the context of a traditional acupuncture clinic that the treatments have emerged.

Science or Folklore?

Much of the confusion surrounding the scientific basis of acupuncture centres on which particular process should be utilised (Advances in Acupuncture, 1979; Pinto, 1978; Pomeranz and Stux (eds), 1989; Vincent and Richardson, 1986; Schoonover Smith, 1988; Bensoussan, 1991). That is, should the selection of acupuncture points used to treat a particular symptom or symptoms be based on the criteria drawn from the conventional medical diagnostic procedures or from so called traditional theories?

The debate is compounded by many versed in the scientific method suggesting that most of the so-called scientific papers concerning acupuncture do not adequately satisfy the scientific method. Therefore the results of many acupuncture studies are seen to be non-scientific or largely anecdotal. Those acupuncturists pursuing the more traditional approach invariably respond by suggesting that the process of acupuncture cannot be considered within the scientific framework without compromising its integrity as an holistic form of therapy (Chu, 1979). In particular the Chinese diagnostic method of pulse diagnosis is regarded by traditionalists as being integral to the process of acupuncture. Traditionalists consider that pulse diagnosis allows assessment of the patient's state of well-being within the framework of Chinese medicine in order that the most appropriate acupuncture points be selected at the time of the consultation.

The author has found in clinical practice that acupuncture point selection based on the diagnostic process of pulse diagnosis tends to suggest the need for selecting different points for different patients who may present with similar symptoms.

It is from the subjective interpretation by the author of the iconography gained from pulse diagnosis, in accordance with the theories underpinning acupuncture, that the ensuing process of acupuncture occurs. That is, within the author's clinic, the process of acupuncture involves the procedures of eliciting diagnostic criteria from pulse diagnosis, followed by the selection of appropriate acupuncture points and, finally, determining the efficacy of the treatment. Figure 1 illustrates the process of acupuncture utilised by the author in his statistical analysis of pulse diagnosis:

PATIENT SYMPTOMS AND HISTORY
leading to
PULSE DIAGNOSIS
leading to
DIAGNOSTIC CRITERIA
leading to
ACUPUNCTURE POINTS SELECTED
leading to
PATIENT COMMENTS AFTER TREATMENT


Figure 1. The Process of Acupuncture

The author has found through stepwise multiple regression and cross-tabulation analysis that there may well be a scientific basis for using the ancient art of pulse diagnosis as a diagnostic procedure in traditional acupuncture. Hence the author's purpose in attempting a statistical analysis of traditional acupuncture treatments was to further the educational base for acupuncture training programmes and to indicate the educational implications of the traditional approach to acupuncture if introduced into the curricula of acupuncture courses. Accordingly, there may be implications for incorporating pulse diagnosis into the design and conduct of acupuncture courses throughout Australia and overseas. It may also influence the assimilation of acupuncture into the primary health care sector in a way that can complement Western medicine.


METHOD

Research Design

The study was an Ex Post Facto consideration of the relationship between:
  1. the symptoms a patient communicates (NPS);
  2. the diagnostic criteria (DC) as determined from pulse diagnosis;
  3. the points used for the first treatment (PUF) as determined from pulse diagnosis;
  4. the points used for the second treatment (PUS) as determined from the pulse diagnosis;
  5. patients' comments after the first treatment (NPC); and
  6. patients' comments after the second treatment (NC).
Despite the weaknesses of Ex Post Facto research as a research method, and the limitations as described in the author's thesis, the author considered that an Ex Post Facto study was the most appropriate research design for maintaining the integrity of traditional acupuncture and pulse diagnosis within the clinic setting. Other research designs such as the use of an experimental double-blind controlled study were not considered to be appropriate in this instance. The author did not want to create an artificially induced clinical environment and thereby alter the process of acupuncture normally utilised in private practice. Central to the author's thesis was the need to investigate the concept of pulse diagnosis as a diagnostic procedure within the context of the process of acupuncture as described.

The problem then was to indicate whether patient symptoms improved after having a course of acupuncture using points selected from pulse diagnosis. The diagnostic criteria obtained from pulse diagnosis was considered the key to point selection and subsequent improvement in symptoms rather than the selection of acupuncture points based on the patients' symptoms alone.

Hypotheses

The two hypotheses tested were as follows:

  1. Hypothesis No. 1. The diagnostic criteria taken from the pulses do not statistically significantly predict the acupuncture points used in the treatment at 0.05 level of significance.
  2. Hypothesis No. 2. The patients' comments after acupuncture are independent of whether the patients' symptoms improved or not.
In formulating the hypotheses, the level of significance used throughout the statistical analysis was 0.05. The assumptions underpinning the hypotheses were:

  1. patients do not need to be of any specific gender or culture to experience improvement in symptoms;
  2. patients do not need to have any particular beliefs about acupuncture in order to experience improvements in symptoms;
  3. acupuncture has its own philosophical foundations which, while differing from the theories and concepts underpinning the bio-medical model, have their own theories and nomenclature.
The significance of the study was to provide the basis for further research into the nature of pulse diagnosis and to indicate that the symptoms a patient communicates are not related to the acupuncture points selected to treat those symptoms. Furthermore, there were implications for acupuncture education should relationships exist in accordance with the hypotheses; that is to say, the study may provide some evidence to suggest that, far from being based on anecdotal evidence, pulse diagnosis may have a coherent basis to its application which is predicted on a scientific framework.

Procedure

One hundred patients cards were randomly sampled from the author's acupuncture clinic. All of the information pertaining to the variables under consideration in the study for the first two treatments were coded into a numerical format suitable for data entry into the SPSS-X (footnote 1) computer program.

The palpation of various pulses on the radial arteries of the wrists and at other sites around the body served as the main form of diagnosis for this study. Pulses were palpated at seven of the Nine Continent Pulse sites around the body in the order listed:

  1. in the depression midway between the calcaneal tendon and the medial malleolus of both feet;
  2. at the highest point on the dorsum of the foot at the point where the dorsalis pedis artery can be palpated;
  3. on the dorsum of the foot in the angle formed by the first and second metatarsals, just anterior to the articulation with the first and second cuniforms;
  4. on the wrist crease at the proximal border of the pisiform bone in the depression at the radial side of the flexo carpi ulnaris tendon;
  5. vicinity of the junction of the first and second metacarpals;
  6. between the middle of the tragus and the mandibular joint where a depression is formed when the mouth is open; and
  7. on either sides of the temples.
At the conclusion of this process the author would then palpate the radial pulses concurrently on both wrists in accordance with the diagnostic concepts associated with traditional Chinese pulse diagnosis. This enabled the author to determine a profile of the patients' health in such a way that specific points could be selected for needling to thereby stimulate a healing response.

Various qualities within the pulses were subjectively interpreted by the author to reflect the patients' health within the framework of traditional Chinese acupuncture. A maximum of 10 diagnostic criteria (DC1-10) were allowed for each patient as interpreted by the author from either the Nine Content Pulses or the wrist pulses. A total of 150 different pulse qualities were recorded and listed alphabetically along with the frequency of occurrence. The author used two or three needles for the majority of the treatments. However there were some treatments which required only one needle and others which may have required four or five. Hence the points were given the coding of PUF1 to PUF5 to allow for the possibility of five needles being used for one treatment.

Table 1 summarises the number of criteria pertaining to each of the major variables under consideration in the study:

Variable Number of Criteria
Patient Symptoms 267
Diagnostic Criteria (taken from Pulses) 150
Points First Treatment 64
Points Second Treatment 70
Comments First Treatment 116
Comments Second Treatment 105

Table 1: Number of Criteria Pertaining to Each Variable

Recoding

It was necessary to recode some of the major variables as the study progressed to facilitate an appropriate framework within the overall encoding structure for the computer program.

Patient symptoms (NPS) were divided into six categories with an appropriate numerical code as follows:

  1. physiological: coded 1;
  2. comment not recorded: coded 2;
  3. musculoskeletal: coded 3;
  4. physiological/stress: coded 4;
  5. emotional/stress: coded 5; and
  6. musculoskeletal/stress: coded 6.
Patient comments after the first treatment (NPC) were re-classified into four categories as follows:

  1. improvement: coded 1;
  2. no change in condition: coded 2;
  3. condition worse: coded 3; and
  4. comment not recorded: coded 4.
Individual pulses from which the diagnostic criteria were gained were also coded as follows:

  1. in the depression midway between the calcaneal tendon and the medial maleollus of both feet: coded P1;
  2. at the highest point on the dorsum of the foot at the point where the dorsalis pedis artery can be palpated: coded P2;
  3. on the dorsum of the foot in the angle formed by the first and second metatarsals, just anterior to the articulation with the first and second cuniforms: coded P3;
  4. on the wrist crease at the proximal border of the pisiform bone in the depression at the radial side of the flexo carpi ulnaris tendon: coded P4;
  5. in the vicinity of the junction of the first and second metacarpals: coded P5;
  6. between the middle of the tragus and the mandibular joint where a depression is formed when the mouth is open: coded P6;
  7. on either sides of the temples: coded P7; and
  8. the pulse qualities taken from the six separate wrist pulses on each wrist were given a collective coding of P8. The complexity of the wrist pulses necessitated the qualities being categorised together thus distinguishing them from those taken from sites around the body already described.
The final matrix incorporating the various codings to each variable was entered into the SPSS-X programme. The data pertaining to each patient was listed alongside the corresponding patient number and the data was analysed as follows:

  1. Stepwise Multiple Regression: P1-8 predicting DC1-10;
  2. Stepwise Multiple Regression: DC1-10 predicting PUF1-5; and
  3. Crosstabulation of NCP against Symptoms (S1-6).

RESULTS

The results of the study have been predicated on the use of pulse diagnosis as a diagnostic tool. Accordingly the author has used the pulses as a means of establishing the most suitable loci for inserting acupuncture needles in order to treat a range of patient symptoms (footnote 2) (Smith, 1993).

Pulse diagnosis is a complex art and, as such, requires a considerable degree of sensitivity in the finger tips. This is because a large number of qualities may be discerned from each individual pulse as well as the combination of pulses collectively. Resulting from this is a profile of the patient's health within the parameters of TCM. Pulse diagnosis assists the practitioner to select and stimulate the most appropriate points from a range of suitable points in order to effect a corresponding improvement in that person's health.

It is due to the complexity of interpreting the pulse qualities that the pulses discerned from around the patient's body (known collectively as the Nine Continent Pulses) have been listed individually and separately from the six pulses which are discerned from each wrist. The Nine Content Pulses have been listed as P1 to P7 respectively while the wrist pulses have been listed collectively as P8. This means that P8 represents all of the diagnostic criteria deduced from the pulse diagnosis other than that information gained from the Nine Continent Pulses. The author considered that the complexity of attempting to quantify the myriad permutations and combinations of the wrist pulses (P8) alone into meaningful data was beyond the scope of the study.

The results from the SPSS-X analysis were categorised into two sections as follows:

  1. Section 1
    1. Statement of Hypothesis No.1.
    2. Stepwise Multiple Regression: P1-8 Predicting DC1-10.
    3. Stepwise Multiple Regression: DC1-10 Predicting PUF1-5.
  2. Section 2
    1. Statement of Hypothesis No.2.
    2. Crosstabulation of NPC against Symptoms (S1-S6).

Section 1

Hypothesis No.1

The diagnostic criteria taken from the pulses do not statistically significantly predict the acupuncture points used in the treatment at 0.05 level of significance.

Stepwise Multiple Regression: P1-8 Predicting DC1-10.

Analysis of this data was concerned to indicate that the pulses (P1-P8) predict the diagnostic criteria (DC1-10).

The information concerning the Stepwise Multiple Regression is summarised below in the form of a matrix showing those predictions which were statistically significant at 0.05 level of significance:

DC 1 2 3 4 5 6 7 8 9 10
P1 * * * *
P2
P3 *
P4 * * *
P5
P6
P7 * *
P8 * * * * * * * * *

Table 2: Matrix of P1-P8 Predicting DC1-DC10

The frequency of prediction by the pulses were as follows:

  1. Pulse 8 (P8): 9 predictions;
  2. Pulse 1 (P1): 4 predictions;
  3. Pulse 4 (P4): 3 predictions;
  4. Pulse 7 (P7): 3 predictions; and
  5. Pulse 3 (P3): 1 predictions.
Conversely consideration of the Table 2 illustrates the frequency of the diagnostic criteria being predicted by the pulses as follows:

  1. DC1: predicted by only one pulse (P8);
  2. DC3: predicted by three pulses (P1, P3 and P8);
  3. DC4: predicted by two pulses (P1 and P8);
  4. DC5: predicted by two pulses (P1 and P4);
  5. DC6: predicted by three pulses (P4, P7 and P8);
  6. DC7: predicted by four pulses (P1, P4, P7 and P8);
  7. DC8: predicted by only one pulse (P8);
  8. DC9: predicted by two pulses (P7 and P8);
  9. DC10: predicted by only one pulse (P8).
Analysis of Table 2 indicates that the following clustering occurred:

  1. Pulses 4, 7 and 8 predicted DC6 and DC7; and
  2. Pulses l and 8 predicted DC3 and DC4.

Stepwise Multiple Regression: DC-DC10 predicting PUF1-5

Analysis of this data was concerned to indicate that the Diagnostic Criteria (DC1 to DC10) do not predict the points used for the first treatment. DC10 was excluded from the analysis due to insufficient data pertaining to DC10. The equations concerning PUF5 were deleted from the analysis due to insufficient data pertaining to PUF5.

Table 3 summarises the results of the Stepwise Multiple Regression:

Entered Variable Dependent Variable Significance
DC-DC9 PUF .7015
DC6 PUF2 .0463
DC-DC5; DC7-DC9 PUF2 .4310
DC-DC9 PUF3 .9173
DC-DC9 PUF4 .9172

Table 3. DC-DC10 predicting PUF-5

Section 2

Statement of Hypothesis No.2

The patients' comments after acupuncture are independent of whether the patients' symptoms improved or not.

Crosstabulation of NPC against Symptoms (S1-6)

The results pertaining to the cross-tabulation of NPC against S2 have been deleted from the analysis due to S2 representing Comments Not Recorded. The cross-tabulation utilised fifty-nine percent of the data pertaining to NPC due to the author only considering those patients who improved or did not improve. Table 4 summarises the relevant data:

Variable Significance Contingency Coeff.
NPC-S1 0.9564 0.04324
NPC-S3 1.0000 0.01611
NPC-S4 0.7996 0.06833
NPC-S5 0.7374 0.07777

Table 4: Cross-tabulation of NPC against Symptoms (S1-6)


DISCUSSION

The results indicate through the use of stepwise multiple regression prediction analysis that the wrist pulses (P8) appeared to be the most predictive of the diagnostic criteria. The pulses taken from the wrist (as distinct from any of the Nine Continent Pulses) involve palpating a complex and subtle arrangement of qualities, more so than for each individual Nine Continent Pulse or the collective of the Nine Continent Pulses. This applies particularly with pulse diagnosis taken in accordance with the Five Phase theories due to the vast array of discernible qualities which may be palpated.

The iconography of the qualities of the pulses is interpreted by the practitioner and represents a profile of the patient's health in terms of Chinese medicine. It makes sematic sense that the bulk of the diagnostic criteria are predicted by the wrist pulses(P8) due to the greater iconography associated with taking those wrist pulses.

More research however is needed to determine the efficacy of the wrist pulses as a diagnostic method. However the results also indicated that several of the Nine Continent Pulses are also predicted various diagnostic criteria. The data does suggest that the Nine Continent Pulses are useful as diagnostic tools in combination with the wrist pulses. More research is needed to accurately determine the frequency of prediction of the diagnostic criteria by the Nine Continent Pulses.

The stepwise multiple regression indicated that the diagnostic criteria did not predict the points used for the treatment. The only exception to this was DC6 (sixth diagnostic criteria) predicting the second point used in the treatment (PUF2). The author considered the prediction of PUF2 by DC6 to be an aberration.

Pulse diagnosis is considered by the author to pertain to that individual patient at the specific time of diagnosis. Literally any acupuncture point may be used by the practitioner if it is in accordance with the complex matrix of diagnosis as indicated by the pulses. The individual point functions are not the only criteria to be considered by the practitioner in the selection process (Smith, 1993).

The intricate relationships of one point to all of the others chosen means that the prediction and ultimate selection of points is an extremely subtle and subjective task. While there is some statistical evidence to suggest that the pulses predict the diagnostic criteria, the relationship of the diagnostic criteria to the final selection of acupuncture points is complicated and diverse when using pulse diagnosis as the major form of diagnosis from which points are selected.

While the author acknowledges that the determination of the diagnostic criteria precedes the selection of the most suitable acupuncture points, the complexity of interpreting the subtlety and subjectivity of such a process suggests that a different research model other than Ex Post Facto may need to be utilised to obtain more meaningful data.

More research is needed to determine the statistical relationship of the diagnostic criteria with the points selected. Crosstabulating patient symptoms against patient comments indicated that the comments at the end of the treatments were independent of whether the patients symptoms improved or not. Although the study did provide some evidence that the process of traditional acupuncture begins with the patient elucidating various symptoms it is the patients comments that conclude the process.

The results of the study suggests that the patients' symptoms are not related to the actual process of traditional acupuncture when pulse diagnosis is used as the predominant form of diagnosis. This makes sematic sense due to the author's treatments being based on the diagnostic criteria as described by the pulses rather than the patient's symptoms.

While it is clear that further research is required into pulse diagnosis as a diagnostic technique, the study does indicate that there is a possibility that pulse diagnosis does in fact have a scientific basis. This in itself may indicate that educational institutions which teach acupuncture may find it useful to include in their curricula the theory and practice of pulse diagnosis if not already doing so.


CONCLUSION

The statistical evidence from the study suggests that the wrist pulses are more predictive of the diagnostic criteria than the Nine Continent Pulses. However, the Nine Continent Pulses were still found to be useful as diagnostic tools in combination with the wrist pulses.

The author was unable to determine that the diagnostic criteria predict the points used for the treatment. A more sophisticated computer programme may be required over and above the SPSS-X to determine further this particular relationship.

The author also found that the patient comments after the treatment were statistically independent of whether the patient improved or not.

Quite clearly more research is needed in this field to determine the efficacy of the wrist pulses as a diagnostic tool. Furthermore, research is needed to clarify the frequency of prediction of the diagnostic criteria by the Nine Continent Pulses and the specific clustering which occurred of the diagnostic criteria in relation to the pulses.

The fact that statistical significances occurred in this study does suggest there may be a scientific framework underpinning pulse diagnosis. Furthermore pulses taken in accordance with Five Phase theory rather than the classic 28 pulse qualities, may be a more appropriate method of taking pulses as a means of traditional Chinese medical diagnosis. The evidence suggests that Five Phase pulse diagnosis is a valid form of pulse diagnosis.

The qualitative approach to acupuncture utilises philosophical considerations borne of thousands of years of clinical use. However, it does appear that the diagnostic art of pulse diagnosis is centred on a coherent methodology which may have a scientific basis. While the Ex Post Facto method of research has proved useful for the study, it does not seem to be wholly adequate to account for the qualitative paradigm to which pulse diagnosis and acupuncture appear to belong.

Educational institutions which teach acupuncture may find it useful to include in their curricula the theory and practice of pulse diagnosis if not already doing so. Integrating pulse diagnosis into the medical and veterinary acupuncture courses may help to juxtapose the many advantages of acupuncture with the advantages of modern medicine. It may also help the graduates of acupuncture courses to better understand the mechanisms underpinning the acupuncture effect within the qualitative paradigm of traditional acupuncture.

Understanding that acupuncture appears to have a coherent methodology while still being inherently different from western medicine may assist people in developing the confidence to learn more about their health within the paradigm of traditional Chinese medicine. It then behoves the acupuncture and medical professions to work together to disseminate information about the benefits of acupuncture that may be appealing to the general public. Combining the many benefits of western medicine with the drug-free and low cost advantages of acupuncture may improve the quality of choice and accessibility of well-being in the provision of primary health care within Australia.


REFERENCES

Acupuncture Ethics and Standards Organisation Inc. (December 1992) President's Report.

Advances in Acupuncture and Acupuncture Anaesthesia-Abstracts. (1-5 June 1979) Beijing The People's Medical Publishing House.

Bensoussan, A. (1991) The Vital Meridian. United Kingdom Churchill Livingstone.

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Chu, L.S.W. et al. (1979) Acupuncture Manual. United State of America Mercel Dekker Inc.

Hadley, M. (9 November 1988) New Zealand Medical Journal. Complimentary medicine and the general practitioner: a survey of general practitioners in the Wellington area.. Volume 101, Number 857.

Kaptchuk, T. (1983) The Web that has no Weaver. London Rider and Company.

Lewith, G.T. (December 1986) The Practitioner Acupuncture. Volume 230, Number 1422.

Maciocia, G. (1991) The Foundations of Chinese Medicine. United Kingdom Churchill Livingstone.

National Health and Medical Research Council. (November 1989) Acupuncture. Canberra 108th Session.

Ng, E.K. (1978) The First Australian International Symposium on Acupuncture in Modern Medicine-Proceedings. Results of 188 Cases of Low Back Pain Treated by Acupuncture. Australia Acupuncture Symposium.

Pinto, C.M. (1978) Acupuncture-Science or Charlatanism? United States of America Dorrance & Company.

Pomeranz, B. and Stux, G. (eds). (1989) Scientific Bases of Acupuncture. Germany Springer-Verlag.

Richardson, P.H. and Vincent, C.A. (1986) Pain. Acupuncture for the Treatment of Pain A Review of Evaluative Research. Volume 24.

Rogers, P.A.M. (1985a) Australian Veterinary Acupuncture Association 1st Annual Conference. Choice of AP Points for Particular Conditions. Melbourne.

Rogers, P.A.M. (15-19 July 1991b) Acupuncture in Animals. The Choice of Acupuncture Points for AP Therapy. Australian Veterinary Acupuncture Association. Proceedings 167.

Rogers, P.A.M. (15-19 July 1991c) Acupuncture in Animals. The Study of Acupuncture Sources and Study Techniques. Australian Veterinary Acupuncture Association. Proceedings 167.

Rogers, P.A.M. (November 1985b) Australian Veterinary Acupuncture Association 1st Annual Conference. Traditional Versus Cookbook Acupuncture. Melbourne.

Rogers, P.A.M. (15-19 July 1991a) Acupuncture in Animals. Traditional Versus Modern Acupuncture. Australian Veterinary Acupuncture Association. Proceedings 167.

Schoonover Smith, L. (January 1988) Nurse Practitioner. Evaluation and Management of the Muscle Contraction Headache. Volume 13, Number 1.

Smith, A. (1993) Master of Education Thesis, Pulse Diagnosis in Traditional Acupuncture. University of Canberra.

Stephen, V.T. (1978) The First Australian International Symposium on Acupuncture in Modern Medicine-Proceedings. Acupuncture and Psychosomatic Illness. Australia: Acupuncture Symposium.

Vincent, C.A. and Richardson, P.H. (1986) Pain. The Evaluation of Therapeutic Acupuncture: Concepts and Methods.. Volume 24.

Conversations

Palmer, R. Conversation with the author dated 9th December 1992.

Letters

Rogers, C. Letter to the author dated 24th September 1992.


Footnotes

1 Statistical Package for Social Scientists.
2 Specific details are contained in the author's Master of Education thesis entitled Pulse Diagnosis in Traditional Acupuncture , (1993), University of Canberra.


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