Pulse diagnosis

The pulse diagnosis is (along with the urine inspection) one of the oldest diagnostic methods. The two great strands of tradition in pulse theory are the Indo-Chinese tradition and the Greek-Arabic-occidental tradition.

Occidental pulse diagnosis

history

Pulse diagnosis has been around since the 5th century BC. Tested in writing: Diogenes of Apollonia as well as Hippocrates and Praxagoras of Kos thoroughly examined the visible or palpable pulse on the hand, temples, neck, loin and knee. They denote palmos the healthy pulse, with sphygmos the excessive pounding pulse, with tromos the trembling and with spasmos cramped pulse. Herophilos of Chalcedon used the water clock to count the pulse rate. Since Archigenes of Apamea (a Syrian doctor who worked in Rome), the Greek pulse theory has been a sophisticated teaching structure: It differentiates between the four times of the pulse - systole, diastole, with a pause in between. The pulse is precisely analyzed using ten pulse categories: size, strength, speed, fullness, hardness ... Special pulses have graphic names, such as the ant-like or gazelle-like pulse. Galen of Pergamon (129–201) gave the Greek pulse theory the classical form that remained authoritative for centuries. The Arab doctor Abu Sahl al Masihi (end of the 10th century) and his pupil, the Persian doctor Ibn Sina (980-1037), called Avicenna in Latin, passed the pulse theory on to the Middle Ages (for example in Ortolf von Baierland ).

Goal of the pulse diagnosis

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Unlike the modern pulse diagnosis of conventional medicine, which mainly focuses on the cardiovascular system, the pulse diagnosis of traditional European medicine appears with a holistic claim: while the urine inspection provides information about the spiritus naturalis and the condition of the four juices, The pulse diagnosis allows insight into the state of the spiritus vitalis , that is, into the “energetic” overall constitution of the organism. By recording further symptoms such as sleep behavior, gender, season, eating habits, etc., the therapist receives further information.

Pulse diagnosis sequence

The person to be examined places his hand comfortably on a small, firm pillow. The diagnostician first looks at the pulse and then loosely places the index, middle and ring fingers on the artery. Depending on the findings of the hand pulse, the diagnostician can also include the temporal or neck pulse in his examination. An essential part of the pulse diagnosis are detailed questions about sleep behavior, nutrition and digestion and the larger context of life.

Pulse types

The occidental tradition knows on the one hand the "ten simple pulse categories" such as size, strength, speed, abundance, hardness, temperature, rhythm ... each of which occurs in three qualities ( too much, too little, suitable ) or other forms. In addition to these approx. 30 possible simple pulses, there is a multitude of composite (complex) pulses, some of which have sound names: worm-shaped, ant-like, mouse-tailed, gazelle-like, saw-shaped, flowing pulse.

Pulse diagnostics in Asian medicine

Pulse diagnosis is an integral part of traditional Chinese medicine (TCM), Graeco-Arabic medicine ( Unani ) and Ayurvedic medicine . In contrast to scientific medicine, TCM knows different qualities of the human pulse in different parts of the body. Ayurvedic doctors check the patient's doshas (vital energies) when diagnosing the pulse and identify any “disorders”.

Pulse Diagnosis in Chinese Medicine

Pulse diagnostics was developed in China between the 2nd and 8th centuries AD, but the beginnings probably go back 2700 years. Other sources attribute the discovery of pulse diagnostics to the legendary doctor Bian Que (approx. 500 years BC). In the 3rd century. AD., At the time of the physician Wang Shuho, the pulse of eleven different parts of the body was carried palpation palpated and assigned different pulse qualities with about 200 different pulse types.

Together with observation (including tongue diagnosis ), diagnosis through hearing and smell and questioning, pulse sensing is one of the four diagnostic procedures in Chinese medicine.

Pulse types

Body pulses

More than the other parts of Chinese diagnostics, pulse diagnostics is a subjective diagnostic procedure and requires experience. In earlier times, pulse sensing was also carried out on different parts of the body that were congruent with certain acupuncture points . These are:

• on the temple on the Taiyang directly above the temporal artery ,
• on the 3E22 directly in front of the ear on the same artery,
• on the cheek Ma3 on the facial artery ,
• on the lower extremities at Le10 and MP11 above the femoral artery ,
• in the case of Ni3 above the posterior tibial artery ,
• in Ma42 and Le3 over the arteria dorsalis pedis ,
• on the upper extremities in addition to the radial pulses from Lu7, Lu8 and Lu9, with the radial pulse via Di4 and with the ulnar pulse via He7.

The state of Qi and blood in the three body regions head, middle body region and lower body region can be determined according to the ideas of TCM by touching these points.

wrist

There are three tactile points on each wrist. One orientates oneself on the radial head, the processus styloideus radii. The radial artery is located somewhat towards the ulnar between the radial head and the tendon of the lateral flexor of the hand. The examiner's middle finger is placed at this point and is in the middle or guan position. If the index and ring fingers are now placed proximally and distally on the middle finger, the ring finger comes proximally to the chi position, the index finger distally to the cun position.

The assignment of the various organs to the pulse contact points has changed again and again. Two different assignments are in use today:

The first is from Wang Shu-he in the third century AD. In the "Classic of the Pulse " ( Maijing ) he defines the following assignment:

	Left	right
front (cun)	Heart small intestine	Lungs large intestine
middle (guan)	Liver gallbladder	Spleen stomach
back (chi)	Kidney bladder	Kidney yang

Li Shizhen, on the other hand, describes the meaning of the different levels in "Simple Explanation of the Pulse Studies of Binhu Lake" ( Bīnhú Màixué瀕 湖 脈 學 / 濒 湖 脉 学) as follows:

	Left	right
front (cun)	heart	lung
middle (guan)	Liver gallbladder	Spleen stomach
back (chi)	Kidney small intestine	Kidneys large intestine

method

The patient should sit or lie down and be relaxed and calm while taking the pulse. Excitement, freezing, physical exertion and food intake immediately before the pulse sensing falsify the result. The arm should rest outstretched, palm up, on a comfortable surface at the patient's heart level. Neither the patient's legs nor those of the practitioner should be crossed during pulse sensing, as this can lead to an energetic mixing of the halves of the body and thus to a falsification of the results. The palpation itself has to take place in the greatest calm and concentration. The average duration of the pulse sampling is approx. 10 minutes, but can stretch over 30 minutes.

In TCM, 28 pathological pulses are usually differentiated. They differ, among other things, in fast / slow, superficial / deep and according to the length and shape of the pulse wave.

Medical studies

So far, only a few, sometimes contradicting, clinical studies have been carried out on pulse diagnostics . From a conventional medical point of view, the assignment of organs to certain tactile points appears arbitrary. Different qualities in the sense of strength, uniformity, frequency, on the other hand, are also known in western medicine and have been proven to be roughly associated with certain clinical pictures (-> see heart rate variability ).

See also

• Heart rate

literature

• Evan Bedford: The Ancient Art of Feeling the Pulse. In: Brit. Heart J. Volume 13, 1951, pp. 423-437.
• Emmet Field Horine: An Epitome of Ancient Pulse Lore. In: Bulletin of the History of Medicine. Volume 10, 1941, pp. 209-249.
• Carola Krokowski, Rainer Nögel: Pulse diagnosis in traditional Chinese medicine. Igelsburg Verlag, Habichtswald 2010, ISBN 978-3-9812165-6-1 .
• Werner Friedrich Kümmel: The pulse and the problem of time measurement in the history of medicine. In: Medical History Journal. Volume 9, 1974, pp. 1-22.
• Berndt Lüderitz , with the assistance of Bruno Inhester: History of cardiac arrhythmias. From the ancient pulse gauge to the implantable defibrillator. Berlin, Heidelberg and others 1993.
• R. Joseph Petrucelli, Albert S. Lyons (Eds.): Medicine - An Illustrated History. Harry N. Abrams, 1997, ISBN 0-8109-8080-0 .
  • As a German first publication by Erich Püschel (Ed.): The history of medicine in the mirror of art. Translated from English by Hans-Thomas Gosciniak and Herbert Graf. Cologne 1980.
• Wang Shu-he: Mai Jing. China, 3rd century AD
• Yang Shou-zhong: The Pulse Classic. Boulder: Blue Poppy Press 2002.

Individual evidence

1. ↑ Aimilios Dim Mavroudis. Ho giatròs Archigénes APO TIN Apamea. Ho bíos kaì tà érga enòs Héllena giatroû stèn autokratorikè Róme (The doctor Archigenes of Apamea. Life and work of a Greek doctor in Roman times). Academy of Sciences, Center for the Editing of Greek Texts, Athens 2000 (= Ponemata. Symboles sten ereuna tes hellenikes kai latinikes grammateias , 3), ISBN 960-7099-83-4 .
2. ↑ Hans Georg von Manz: Archigenes of Apameia. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 96.
3. ↑ Hermann Schöne : Markellinos' pulse theory: a Greek anecdoton. In: Festschrift for the 49th Assembly of German Philologists and School Men. Basel 1907, pp. 448-472.
4. ^ Marion Ónodi, Johannes G. Mayer , Ruth Spranger (eds.): The German medical texts in the manuscript BV 3 of the Archdiocesan Library Erlau (Eger). On the tradition of Ortolf's Pultractat. In: Gundolf Keil, Johannes G. Mayer, Christian Naser (eds.): "Make a teutsch puech". Investigations into the local language teaching of medical knowledge. (= Ortolf studies. Volume 1). Wiesbaden 1993 (= knowledge literature in the Middle Ages. Writings of the Collaborative Research Center 226 Würzburg / Eichstätt. Volume 11), pp. 402–442.
5. ↑ Axel W. Bauer : Cardiovascular diseases. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. Walter de Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 722-728, here: pp. 722 f.
6. ^ Edzard Ernst : Complementary medical diagnostic procedures . In: Dtsch Arztebl. 102 (44), 2005, pp. A-3034 / B-2560 / C-2410.

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