Awakening a Child From a Vegetative State with Xing Nao Kai Qiao Acupuncture

Persistent vegetative states (or “unresponsive wakefulness syndrome”) arise following brain damage leaving the patients in a state of partial arousal. While potential outcomes will vary depending on the causal factors, after 3-6 months chances for a complete recovery are considered low and generally get lower as time progresses ( 1 ). For children under western medical care, one study, described potential outcomes as follows: “The long-term outcome for children discharged from the hospital in a persistent vegetative state was poor. Forty percent of the patients died and, at best, children showed only minimal awareness after an average of 4.5 yrs. Care costs were > $90,000/yr per patient.” ( 2 ).

Stroke recovery and the treatment of related neurological conditions are often treated by Chinese Medicine. A few years ago I wrote a brief review of a documentary entitled 9000 Needles. This documentary follows a Kentucky man’s struggle towards recovery following a brain stem stroke. After exhausting all western options and much of their insurance coverage and finances he heads to a famous Traditional Chinese Medicine hospital in China, the “First Teaching Hospital of Tianjin University“. Within their stroke center which utilizes the work of Dr. Shi Xuemin and his Xing Nao Kai Qiao (“activating the brain and opening the orifices”) treatment methods he exits a few months later walking nearly unaided and able to communicate fairly clearly.

Publishing in the frontiers in medicine journal a team using Dr. Shi’s system recently submitted a case report of the return of a 5 year old, 3 months into a persistent vegetative state, to a nearly completely recovered state after 50 days of treatment. The treatment was offered within the Xi’an Encephalopathy Hospital of Traditional Chinese Medicine in Xi’an, China.

The treatment offered was a combination therapy including Dr. Shi’s “Xing Nao Kai Qiao” acupuncture method, oral “An Gong Niu Huang Wan” Chinese herbal formula, and “Xing Nao Jing” herbal formula via IV drip. After the 50 day treatment the team reported that the child had “his health significantly improved and is nearly similar to that of a healthy child“. In this article, I’m going to explore the basics of their treatment – note, however, that I am only marginally familiar with the approaches of Dr. Shi and do not have a relationship with these particular researchers.

Dr. Shi’s “Xing Nao Kai Qiao”, “activate the brain and open the orifices”, method is drawn from his many years of clinical experience, particularly with stroke and other neurological conditions. The general points used are as follows. The primary points are always used and then some additional points would be used for each individual case.

  • Main Points:
  • PC 6 “inner pass” – influences the median nerve, used in TCM for a range of psychological issues, nausea, and opening and relaxing the chest.
  • SP 6 “three yin intersection” – influences the tibial nerve, used in TCM to tonify the yin and the blood for a range of psychological and menstrual conditions, clearing what we call “heat” in the blood.
  • GV 26 “water through” – with PC 6 forms a set of “command points” for the chest, heart and epigastrium areas, a very useful point for recovering from shock and/or fainting, as well as other psychological and neurological conditions such as epilepsy.
  • Secondary Points:
  • HT 1 “highest spring” – used for a range of shoulder and arm issues, but also tension in the chest and anxiety issues.
  • LU 5 “cubit marsh” – useful for a range of shoulder/arm/elbow issues, but of more relevance here for removing what we would call phlegm heat in Chinese Medicine.
  • UB 40 “bend middle” – another “command” point, this one for the lumbar region, but of more relevance here, used for clearing heat in cases of heatstroke and related issues.
  • Dysphasia Points:
  • GB 20 “wind pool” – an important point for dispelling “wind” in Chinese Medicine terms, symptoms such as vertigo, dizziness, numbness, etc., a “cva” in Chinese Medicine terms may be called a “wind stroke” alluding to the damage a strong “wind” can do.
  • GB 12 “completion bone” – another point for dispelling “wind” in the head,
    tinnitus, tremors, also some cases of insomnia and/or anxiety.
  • SI 17 “celestial countenance” – a “window of the sky” point, used to open the throat but also has a role in improving circulation to the brain.
  • Asphasia Points:
  • CV 23 “ridge spring” – commonly used in stroke patients to aid speech and swallowing.
  • Jinjin and Yuye “golden fluid and jade fluid” – a pair of “extra points” used for post stroke asphasia, but also other issues with the tongue and/or speech, or swelling of the tongue that restricts breathing.
  • Hand and Finger Paralysis:
  • LI 4 “union valley” – a commonly used point to release wind-heat or wind-cold in Chinese Medicine terms, strengthens immunity, used for many facial issues involving pain or mobility.
  • Bafeng and Sifeng “eight winds and four cracks” – “extra points” between the toes (bafeng) and the finger joints (sifeng) clinically noted for issues such as malaria and deep digestive issues, but used as strong local stimulators for stroke and other conditions.

Treatment is, if possible, offered twice daily for 10 days per course. Often 3-5 courses of treatment are required. The case report here, as an example, was 50 days of consecutive treatment.

Further exploration of Dr. Shi’s work can be started by reading “Shi Xuemin’s Comprehensive Textbook Of Acupuncture And Moxibustion, Volumes 1& 2“. Which is not a text exclusively related to stroke, but it provides a good framework and case studies from which a practitioner can begin to understand some of Dr. Shi’s methodology.

Now onto the Chinese herbal formula “An Gong Niu Huang” or “Calm the Palace Pill with Cattle Gallstone”. This formula is a strong herbal formula primarily used in patients who are unconscious and/or have had a stroke. The herbal ingredients are generally as follows:
Cattle Gallstone (Niu Huang), Rhinoceros Horn (Xi Jiao) * substituted with Water Buffalo Horn (Shui Niu Jiao), Navel Gland Secretions of Musk Deer (She Xiang), Coptis Rhizome (Huang Lian), Baical Skullcap Root, Scutellaria (Huang Qin), Cape Jasmine Fruit, Gardenia (Zhi Zi), Realgar (Xiong Huang), Borneol (Bing Pian), Tumeric Tuber (Yu Jin), Cinnabar (Zhu Sha), Pearl (Zhen Zhu).

This particular formula has been used for hundreds of years for a range of central nervous system issues and for resuscitation. A fairly lengthy clinical exploration of this formula, case studies and clinical applications may be read here.

The other formula that was given via IV, Xing Nao Jing, is used for stroke and other neurological conditions. A study exploring how it helps may be read here.

Exploring this case study is a useful enterprise for practitioners of Chinese Medicine as well as neurologists and other specialists from the western medical side. In many of these types of cases a combination approach of western and eastern medicine would in most cases be best. It is nice to see that type of integration happening in Chinese hospitals and perhaps with more studies of this nature that interest in integration will continue in western countries as well.

Acupuncture for Insomnia – Mechanisms Explored

A range of research puts chronic insomnia rates around 30% and those with at least one bad night per week much higher, around 65%. Now the one off night of sleeplessness is probably just annoying and part of life. We all have times where we may have too much on our mind or a period of time with unresolved emotions towards events in our lives.
More chronic experiences however begin to contribute to more significant health effects.

Research shows relationships between any number of health issues and poor sleep. Possible health effects include obesity, diabetes, hypertension, anxiety, depression, alcohol abuse, and more ( 1 ). Chinese Medicine, both Chinese herbal medicine and acupuncture, has long been used to treat a range of sleep disorders, including generalized insomnia. When insomnia is properly diagnosed in the Chinese Medicine context (see “treating the cause and not the symptoms“) and the treatments are properly tailored to the individual, it generally responds quite well. Our acupuncture for insomnia page has some of the possible patterns and basic treatment protocols.

Approximately 7 years ago a team of researchers from Changchun University of TCM in China conducted a study exploring the effects of a certain point protocol and needling method on insomnia and the flow of blood in the brain ( 2 ).

In their study they divided 60 patients with insomnia into a treatment group and a control group. Within the treatment group they utilized the following acupuncture points:

  • Sishencong (God’s Cleverness) – a set of 4 “extra points” at the top of the head surrounding GV 20. Can be used as a calming point for issues such as insomnia and adhd, for example, but also as a nourishing function for conditions such as stroke or epilepsy.
  • HT 7 (Spirit Gate) – a calming point that strengthens the “blood” in Chinese Medicine terms – among other functions. Generally useful for anxiety, insomnia, panic attacks, palpitations and more.
  • SP 6 (Three Yin Intersection) – a broadly useful point in Chinese Medicine that strengthens the yin (the cooling/calming aspect of the body) and the blood – for a range of “spleen” disorders (see “My Spleen is What?” for more), and issues such as insomnia, anxiety, hypertension as well as a range of menstrual issues.

In the control group they used UB 62 and KD 6 – which can be calming and in some cases useful for insomnia, but are fairly different in function from the main treatment points.

In their study they concluded finding a 93.3% total effective rate in the treatment group and that peak velocity of systolic and diastolic blood flow velocity within the middle cerebral artery, basilar artery and vertebral artery were increased. There were changes in both groups, but the treatment group noted a stronger therapeutic effect for insomnia and stronger changes in blood flow.

With that study finished, 7 years later, a group from the same university as well as others from the China Academy of Chinese Medicine Sciences and the Shanghai University of Traditional Chinese Medicine conducted a follow up study to look at how these points helped with insomnia.

Practitioners of Chinese Medicine are very far beyond the “does it work” stage with many conditions. Due to this we are either happy with the fact that it works and we leave it at that or, for some, we put effort into finding out how it works in western terms to see if we can improve results. Improvement in results would be both in sheer volume of people we can consistently help as well as working towards reducing the number of treatments required to get the desired outcome. For my clinical practice, these western understandings put into the overall context of Chinese Medicine are quite helpful, not exclusively so, but helpful contextually.

To explore the previous study more deeply, this team used rats divided into 3 groups, a control, a sleep deprivation group and an acupuncture treatment group. In the sleep deprivation group they noticed upregulation of the following mRNA contents:

  • BDNF (Brain-derived neurotrophic factor) – a protein found in the brain and periphery that acts on the central nervous system and peripheral nervous system, helping existing neurons to survive and grow new neurons and synapses. When this is downregulated, through stress for example, then it impacts mood and ultimately sleep ( 3 ).
  • SYP – another protein found more broadly through the brain and the spinal cord that plays a role in spatial learning, exploratory behavior and object recognition. When increased in plays a role in fostering overall intelligence ( 4 )
    and when decreased a range of behavioral/intellectual issues may arise.

What the researchers found is that the protocol used in the previous study, what was called “tranquilizing and allaying excitement method”, increased the levels of BDNF and SYP in the hippocampus, thus providing a critical mechanism to improve learning and memory damaged by insomnia. In that previous study, however, there was also a therapeutic effect for insomnia itself so it appears to offer both a treatment of the symptom and a path towards resolution of the effects of sleep deprivation.

Clinically speaking this is generally what we see in the world of Chinese Medicine, particularly for insomnia and related conditions. That is, we see both a symptomatic resolution as well as something deeper shifting/resolving which makes the resolution hold sometimes for months, years, and even permanently with no further treatments of any kind. This in many ways is what we mean by “treating the cause, not the symptoms” and is certainly the goal, if not the entire raison d’ĂȘtre, of Chinese Medicine.

Acupuncture Resolves Menstrual Cramps Regardless of Treatment Frequency and Technique

Acupuncture is used successfully to resolve a wide range of women’s health issues. Menstrual issues such as dysmenorrhea (menstrual cramps) are among those issues that are treated frequently and tend to do quite well with proper treatment.

While a bit technical, our acupuncture for dysmenorrhea section, lists basic point protocols for some of the more common related Chinese diagnoses. (see treating the “cause vs. the symptoms” for general info on treating patterns in Chinese Medicine vs. conditions as in Western Medicine.)

As one might expect in a many thousands of years old system of medicine there are a variety of approaches to the treatment of issues such as dysmenorrhea. Treatments will vary by points chosen, needling style (even needling, strong manipulation, etc.), techniques used (for example, electro-acupuncture and/or needling with moxibustion), and further variations of treatment frequency and duration of needle retention.

For the most part there are no “right” or “wrong” approaches, but ideally treatment is tailored to the individual and their specific circumstances.

Now even though there are technically no “right” or “wrong” approaches – it is a generally accepted idea that choosing the right techniques does matter as far as clinical outcomes go. Certainly what points are used will make a clinical difference. But what about how often you see the patient, or whether you use electroacupuncture or not?

To explore the outcomes of various approaches, a group of researchers from the National Institute of Complementary Medicine and the School of Nursing and Midwifery at Western Sydney University designed a study to look for differences between treatment frequency/timing with menstruation and electro vs. manual acupuncture.

Researchers recruited 74 women with dysmenorrhea and randomly divided them into 4 groups:

  • Low Frequency Manual Acupuncture – treated once per week with regular body acupuncture.
  • High Frequency Mannual Acupuncture – treated 3 times in the week prior to the onset of menstruation with regular body acupuncture.
  • Low Frequency Electro Acupuncture – treated once per week with electroacupuncture.
  • High Frequency Electro Acupuncture – treated 3 times in the week prior to the onset of menstruation with electroacupuncture.

All woman received one acupuncture treatment within 48 hours of their menses and then followed protocol depending on their grouping. Treatment was offered over 3 months (12 treatments total) and evaluated during those 3 months as well as 9 months later at the one year mark.

The treatment that was offered was tailored by the acupuncturists to their individual tcm diagnoses – for liver qi stagnation or blood deficiency as examples. But in no case were more than 7 acupuncture points used.

The researchers found that all groups received reduction in their menstrual pain with effectively nonexistent differences between the groups and these improvements were sustained at the 12 month follow up between all groups.

Those who received 3 treatments the week before menses recorded more “quality of life” improvements than the low frequency groups and both manual acupuncture groups saw less need for any analgesic usage compared with the EA groups. Of all the groups in this study, the high frequency manual acupuncture group had the strongest reduction in secondary menstrual symptoms compared with all of the other groups.

We walk away from this study with a clear understanding that acupuncture is quite effective for menstrual cramps regardless of treatment frequency or whether you use electroacupuncture or not. This is useful information, particularly in countries where acupuncture is an out of pocket expense in the sense that, as a practitioner, you should feel free to experiment with treatment frequency. Seeing how little you can treat and still get the same response. How little intervention you can do and still get the same response (or even better). Less is often more, particularly in the world of Chinese Medicine.

Abdominal Acupuncture for Neck Pain – Zhiyun Bo Techniques (Study)

Neck pain, statistically speaking, will be experienced by nearly 50% of the global population in their adult lifetime. It can be a very painful condition, which due to how we use our necks for day to day life, can limit social and physical activities for approximately 25% or so of sufferers. Without other interventions, a certain amount of these will obtain surgery which may offer limited value and it may also restrict mobility.

Acupuncture is effective across the board for all types of pain from nearly any cause and neck pain is no exception. What differs in the approach of acupuncture, generally speaking, is the depth of the approach – treating the cause and not the symptoms. So the purpose is not so much to manage pain in a better way than opiates, for example, but to unearth the contributing factors and resolve them. While you can certainly use acupuncture to “manage” pain, and in complex cases this is at times necessary, the overarching goal is to “resolve” it.

Now aspects of the study I’m discussing today will come as no surprise to most acupuncturists, but to the public it may be interesting to see treatments for neck pain being studied that don’t touch the neck at all – or even get close to it.

Rather than trying to show the extensive value of acupuncture in the paragraphs above, my intent was to lead to a different way of thinking of how Chinese Medicine focuses on health issues – approaching the symptoms from a much deeper causative level. And due to this deeper approach, in general terms, you may end up with treatment approaches that to the layperson may seem like you are not understanding what their problem is.

In my clinical practice, patients are at times concerned – sometimes gently, sometimes not so gently – as I begin to insert many needles completely away from where they think they should go. They are concerned that I perhaps simply forgot what they were asking for help with as they cannot understand why I am not just needling around where they hurt. While there is such a thing as what we call “local” or “ashi” (“where it hurts”) needling, that is rarely, if ever, the way to truly resolve a persons condition.

Abdominal acupuncture is one such “sub-system” within acupuncture that may at times seem less intuitive (except for digestive issues, I suppose) than “body” acupuncture. In the study that I am going to explore today, researchers from the Pok Oi Hospital in Hong Kong and the School of Chinese Medicine within the Chinese University of Hong Kong set out to show the value of abdominal acupuncture for neck pain.

The researchers recruited 154 patients with neck pain ranging in age from 18 to 65 years of age and divided them into an abdominal acupuncture group and a sham abdominal acupuncture group. Treatment was provided over 6 weeks and then a 14 week followup was performed.

The treatment group received acupuncture at the following abdominal area points:

  • CV 12 “Central Venter” – used for a range of stomach and spleen patterns in Chinese Medicine terms, which run the gamut of nearly all digestive issues, useful for stress related digestive issues that arise with other symptoms such as insomnia and/or anxiety.
  • CV 4 “Origin Pass” – arguably one of the most important points in the body for strengthen nearly any weakness of what we call the qi, yin, yang, or blood of the body. Useful in cases of deep exhaustion, chronic fatigue, certain fertility issues, back pain, etc.
  • KD 17 “Shang Bend” – generally used for tonifying the weakness involved in a range of digestive issues and/or abdominal pain.
  • ST 24 “Slippery Flesh Gate” – used for what we call “rebellious qi” in Chinese Medicine which can be issues such as vomiting, reflux, etc. – but also has use in resolving what we call phlegm which is a way of describing some of the metabolic and inflammatory relationships in the digestive system to certain psychiatric conditions such as manic depression, for example.

After insertion the needles were retained for 30 minutes and a TDP “heat” lamp was applied during that time 30cm above the navel. Patients were treated 3 times each week for 2 weeks (6 total treatments).

This particular selection of points comes from the work of Dr. Zhiyun Bo. His work is explored in the english text “Mastering the Art of Abdominal Acupuncture: A concise guide to treating numerous painful conditions”.

Even for a layperson, aspects of this point protocol would seem somewhat obvious – shutting down systemic inflammatory markers via the digestive system as opposed to working to locally remove inflammation in the neck. Again, treating the root and not the symptoms.

Researchers found that this abdominal acupuncture protocol for neck pain was quite effective, finding that:

“the improvement in NPQ scores in the abdominal acupuncture group was even more significant at 14 weeks from baseline. Patients in the abdominal acupuncture group also exhibited significantly greater improvements in intensity of neck pain and a few quality-of-life measures than those in the sham abdominal acupuncture group, without any serious adverse events.”

Now during this study the patients were asked to refrain from other techniques such as tuina (Chinese medical massage), cupping, and other regular acupuncture treatments – some or all of which would be quite helpful in many circumstances. In most clinical situations you would be combining abdominal points with other body acupuncture points as well as other associated techniques as indicated by the need of the individual patient and your own clinical experience. It is valuable to keep in mind, however, that often less is more and things may not be quite what they seem…

Coffee, Tea, and Acupuncture for Pain – They May Not Mix

Acupuncture is widely used for any number of health issues. Chronic pain, of any nature, is one of the most common reasons for visiting an acupuncturist. The effectiveness of acupuncture on pain generally has been shown clinically as well as within many published studies. What hasn’t been looked at as strongly is what potential influencers may block the positive effects of acupuncture.

I get asked fairly often can I do “x”, “y” and/or “z” after acupuncture. For the most part my answer is always – yes. I generally counsel people against strongly vigorous exercise right after acupuncture (not that most people feel like doing that) and to avoid heavy meals, but other than that I’m of the opinion that there is little that can be done to strongly block the effect of acupuncture.

An interesting study came out from researchers at the Eastman Institute of Oral Health within the University of Rochester in New York. They looked at the effects of having caffeine in the body when having acupuncture for pain. The researchers were following up on a previous study where they were trying to deeply explore how acupuncture helps with pain. This initial study drew the following conclusion:

Although acupuncture has been practiced for over 4,000 years, it has been difficult to establish its biological basis. Our findings indicate that adenosine is central to the mechanistic actions of acupuncture. We found that insertion and manual rotation of acupuncture needles triggered a general increase in the extracellular concentration of purines, including the transmitter adenosine (Fig. 1), which is consistent with the observation that tissue damage is associated with an increase in extracellular nucleotides and adenosine36

This nucleoside adenosine will help slow down nervous system activity, promotes sleep, dilates blood vessels, etc. These functions will effectively limit or block pain signals. The stimulant effect of caffeine is primarily the result of caffeine binding to these molecules and in effect blocking their downregulating functions – thus waking you up ( 1 ).

In effect, then, the pain relieving effect of acupuncture is due to increasing adenosine (among other factors). So as these researchers speculated, caffeine blocks this effect. They concluded in their study that:

a trace amount of caffeine can reversibly block the analgesic effects of acupuncture, and controlling caffeine consumption during acupuncture may improve pain management outcomes

Interestingly they even tried injecting caffeine at the acupuncture point to see if it was only systemic caffeine that created the issue or if it was locally blocking the door of the acupuncture point so to speak. It appears, at least from this study, that caffeine closes the door to certain functions of acupuncture with particular relation to pain – although possibly many others.

More studies will have to be done to further explore this – both to see what other functions caffeine may be blocking and to see if other acupuncture techniques can override the binding of adenosine by caffeine. For now, it may be a good idea to have patients not have caffeine before their treatment, particularly if they are coming with chronic pain issues.

Successful Long Term Treatment of HIV/AIDS with Only Chinese Herbal Medicine

Traditional Chinese Medicine (TCM) includes acupuncture, Chinese herbal medicine and a host of other techniques. The majority of TCM has numerous studies and thousands of years of clinical information showing positive effects on immunity and inflammation among many other issues. HIV/AIDS is by any standard an extremely complicated condition and proper treatment is absolutely critical. This is in part for the longevity and wellness of the patient but to also reduce the spread of the virus.

What is presented within this article is a series of case studies of poor Chinese villagers with HIV who chose to participate in a TCM only treatment study. By all accounts modern western therapy for much of the world is either difficult to access and/or afford or the side effects are unmanageable with their level of available care making any or complete use of western drugs unfeasible. While the results presented by these practitioners are clinically interesting, much more research would have to be done to understand more defined and reliable Chinese herbal medicine approaches.

TCM has long been used to limit or balance the side effects of many strong western medications and there has always been a place for the combination of the two approaches (at least from the Chinese Medicine side of that equation). Within the world of HIV/AIDS care TCM has played an important role as well around the world. In the US one of the first TCM related public health services for HIV+ patients was the AIDS Care Project in Boston. The AIDS care project (1989-2014) provided biweekly acupuncture treatments along with herbal medicine care by donation via government public health funding. The work of that project is still carried on in satellite clinics and via individual acupuncturists. There are a number of others projects around the country that follow this model as well as projects such as the global acupuncture project who provides training and treatment to communities at need around the world.

While much TCM related research and effective clinical work has been done to alleviate side effects of both AIDS and western medications, not as much has been done to show treatment without western medications. A team of researchers from the Institute of Biomedicine at Jinan University in Guangzhou China and the Public Health Preparedness for Infectious Disease Program at The Ohio State University in Columbus Ohio set out to explore the TCM only/TCM primarily approach.

Publishing in the AIDS research and human retroviruses journal the researchers explored case studies of 9 rural Chinese patients with AIDS. The patients ranging in age from 51 to 67 were from an “AIDS village” in Anhui Province and had contracted HIV around 1994 through the donation of plasma. While there were over 40 patients in the village at the time, only 9 were confident enough in TCM to participate in the study. The patients were treated either with TCM alone for a 9 year span or TCM alone for a 5 year span followed by occasional antiretroviral therapy. The TCM treatment included a formula comprised of 13 herbs including Ren Shen (ginseng) and Huang Qi (astragalus), both of which have effects on digestion/immunity/weakness of the body and Huang Qin (skullcap), which clears heat in the digestive tract and elsewhere.

As a clinical sidenote herbal therapy would ideally be tailored to each individual. While there a host of tonifying herbs that are critical to provide aid to the bodies immune system, treatment would be balanced with others that clear heat, aid digestion, aid the liver, harmonize the digestive tract, and/or clear pathogenic influences.

The researchers found that in 2016 eight of the nine followed patients had undetectable viral loads and the ninth had a very low viral load and they were all in good health overall. Through various diagnostic mechanisms the researchers were able to confirm that these 9 patients were not anomalies such as “long-term non-progressors” or “viremic controllers” – that is they were not by all clinical accounts from the group of people that seem to be HIV+ but display little or none of the clinical symptoms (by some accounts this is between 1% and 5% of all HIV+ patients).

According to the researchers these case studies show that TCM has the potential to “become a functional cure for HIV/AIDS”.

Being far more cost effective than western medications and very likely far less damaging over the long-term, more research towards the TCM only approach is warranted.

Pulse Diagnosis in Chinese Medicine – Starting A Modern Scientific Method

Chinese Medicine is as much an art as it is a science. One of the strongest values of Chinese Medicine is how a practitioner can look deeply into each patient and find the causal factors driving their illnesses and tailor a treatment directly to them. There is an intuitive part to this, an artistic part and a scientific part – all of which are fostered by training and clinical experiences.

To uncover and ultimately treat these underlying diagnostic “patterns” the Chinese Medicine practitioner utilizes many diagnostic tools. The most common ones are described within the “examinations and diagnosis” section on our theory site.

Of these tongue diagnosis and pulse diagnosis are arguably the most important and most clinically valid. Tongue diagnosis has the benefit, in my opinion, of being far less subjective – in other words more practitioners will see the same things on the tongue in the same way when compared with how they might come to different conclusions with the pulse. The pulse, however, will show a wider range of imbalances and can be extremely useful in deciphering the root of mixed patterns.

In pulse diagnosis you are looking for certain qualities of the pulse (not just rate as most would assume). So terms such as “slippery”, “wiry”, etc. are used in conjunction with certain pulse positions. There are a few alternate pulse positions to check on the wrist and then others elsewhere on the body. A common positional understanding includes 3 positions on each wrist along the radial artery starting behind the wrist crease. On the left wrist closest to the crease you see relationships with the heart system, the liver behind that and the kidney behind that and on the right wrist you have the lung system at the crease, the spleen system behind that and the mingmen behind that.

Left Wrist Right Wrist
Cun (inch) - 1st position HT / SI LU / LI
Guan (barr) - 2nd position LV / GB SP / ST
Chi (foot) - 3rd position KD / UB Mingmen / Lower Burner

A basic diagnostic example might be as follows: For someone that we might reference as “stressed out” in the west – they might have what we call “liver qi stagnation” in Chinese Medicine. We wouldn’t, however, just assume they have this diagnosis because they describe being “stressed out” (see “treating the cause and not the symptoms” for more on this) – we would come to this conclusion from using all of the diagnostic tools referenced above. Their tongue might be purple which can indicate “stagnation”
particularly on the sides which is the “liver” area on the tongue, and their pulse might be “wiry” – particularly in the 2nd left wrist position which correlates with the liver system. That, of course, is a very simplified example.

Now one of the problems with pulse diagnosis as I hinted at above is that it can be quite subjective once you get beyond the more simple cases. You could line up 50 tcm doctors and have them all look at the tongue and pulse and with the tongue you would (just guessing here) get probably 40 out of 50 in agreement with only mild nuances differing, but with the pulse you might get 10 out of 50 – partially because it is offering more information admittedly and there are different systems of correlations. But, in my experience and opinion, it would be different (an interesting study to perform for those researchers that might be reading this).

To compensate for this arguable lack of precision a group of researchers from Taiwan recently conducted a study looking at more scientifically measurable pulse variations and trying to group them into diagnostic categories. Involving researchers from the division of cardiology at the Chang Gung Memorial Hospital and the Institute of Traditional Medicine at National Yang-Ming University among others they aimed to correlate a range of pulse wave parameters and heart rate variability with standard TCM diagnoses.

To perform the study they recruited 69 relatively healthy volunteers and utilized a wrist blood pressure cuff called “ANSWatch” and obtained pulse readings at the left guan position (the liver area). Utilizing a range of measurements including blood pressure, augmentation index and subendocardial viability index they tried correlating these to each volunteers diagnosis in Chinese Medicine terms.

The researchers found:

  • Those with qi deficiency had higher augmentation index scores and lower diastolic blood pressure.
  • This with yang deficiency had lower systolic blood pressure, lower pulse pressure and lower dP/dt max (a measure of ventricular contraction strength).
  • This with damp-heat had higher subendocardial viability index scores.

Now there are a million caveats with a study of this nature all indicating that there is much more research to be done before this would lead to clinically valid ways of obtaining or helping to confirm diagnoses in Chinese Medicine. But this is a nice approach to using modern western diagnostic tools with time proven traditional medicine tools. Particularly since proper diagnosis is so crucial within Chinese Medicine to obtain the best clinical outcomes.