Diagnosis In San Francisco Health

[Cute little bird] Planning: Implications For a Pacific Rim

City

By Richard Kass

Dissertation, Social Welfare Department

University of California, Berkeley

Copyright, (c) April 1990

By Richard Kass

Questions, comments, or requests may be addressed to:

Michael Broffman, L.Ac. or Michael McCulloch, L.Ac. at chinamed@well.com

Pine Street Chinese Benevolent Association

124 Pine Street

San Anselmo, CA 94960

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Abstract

The purpose of this dissertation was twofold: 1) to provide background

material on the Asian American culture and dual health care system in San

Francisco; 2) to examine how Traditional Chinese pulse diagnosis (a

renowned ancient diagnostic technique) can be used to help integrate the

dual health care system in San Francisco. The overarching vision for the

project is a culturally responsive health care system in San Francisco

which effectively controls the spread of chronic disease.

Data collection was carried out at On Lok Senior Health Services in San

Francisco. Ten subjects were examined by two Traditional Chinese

physicians; one using a Traditional hand palpation method and the other

using a computer assisted pulse detection device. The physicians examined

the pulse of the same 10 subjects and attempted to: 1) obtain the same

pulse readings on a given subject (a test of the reliability of pulse

diagnosis); 2) match subjects with their corresponding medical files on the

basis of pulse analysis alone (a test of the validity of pulse diagnosis).

Three precautions against experimenter bias were observed: 1) the subjects

sat behind a screen with only the diagnostically relevant area of their

wrists visible to the two physicians (a special glove was worn); 2) no

contact was allowed between the two examining physicians at any time during

the study; 3) the pulse examination schedule was altered in the middle of

the day in order to avoid any detectable patterns.

In the general and individual pulse assessment sections the physicians

achieved a significant p<.0001 reliability finding. 463 matches out of a

possible 660 matches (70%) were achieved in the individual pulse section

(p< .0001 for 463 or more matches).

Other findings suggested that there may be some validity to Traditional

Chinese pulse diagnosis; one of the physicians was able to achieve a

significant result (p<.047) for six correct subject/medical file matches

when 1st, 2nd, & 3rd choices were taken into account. However, this

conclusion must be tempered in light of a serious methodological problem

which may have influenced the results.

Acknowledgments

The kind cooperation of John Shen, On Lok Senior Health Services staff and

clients, Dr. Michael Broffman, L.Ac., and Dr. Michael McCulloch, L.Ac. is

greatly appreciated.

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Table of Contents:

Traditional Chinese Pulse Diagnosis: Introduction & Review of the Current

Literature

Investigation of Traditional Chinese Pulse Diagnosis

* Subjects

* Materials and Equipment

o General Pulse Section

o Sub Pulse Type Section

o Individual Pulse Section

* Procedure

Data Analysis

* Reliability of Pulse Diagnosis

* Validity of Pulse Diagnosis

Discussion

* Introduction

* Significant Results

* Conclusion

Traditional Chinese Pulse Diagnosis: Introduction & Review of the Current

Literature

Traditional Chinese physicians use palpation to differentiate 31 pulse

patterns at 18 positions on the right and left wrists. This delicate

technique reportedly provides:

1. A genuine early diagnosis of functional disorders which, if left

untreated, eventually will produce degenerative or malignant organic

changes;

2. The specific and comprehensive, all-inclusive determination of all

factors having a bearing on complex pathological processes (at the

roots of chronic or constitutional diseases);

3. Specific and comprehensive and direct appreciation of the immediate

effects of any applied drug or therapeutic measure or agent

(indispensable for the immediate follow-up of any therapeutic measure,

as well as in the assaying of new drugs). (Porkert, 1983).

Traditional Chinese pulse diagnosis is the single most important technique

in Traditional Chinese medical diagnosis (Broffman & McCulloch, 1986). One

problem with Traditional Chinese pulse diagnosis in the United Sates is

that it tends to be unreliable; rarely will two physicians come up with

identical pulse assessments for a given patient. This circumstance has: 1)

discouraged physicians from performing comprehensive pulse examinations on

their patients jeopardizing treatment success); 2) increased skepticism

toward Traditional Chinese medicine (pulse diagnosis and other aspects of

Traditional Chinese medicine are suspected of being invalid); 3) been a

barrier to the scholarly investigation of Traditional Chinese medicine

(clinical trials which are not based on accurate and comprehensive pulse

diagnoses are inconclusive).

Advocates of Traditional pulse diagnosis contend that the problem lies in

the application of the technique and not with the technique itself. They

argue that: 1) pulse diagnosis is extremely difficult to learn (few

physicians have the tactile acuity to detect subtle variations at three

levels of palpation pressure); 2) few physicians are willing to devote the

necessary time to master the technique (5-10 years of supervision is often

needed).

Several electronic devices have been developed which reportedly achieve

more accurate measurements of energy at acupuncture points and meridians as

well as make such technology more accessible to physicians (Laub, 1983;

Lee, & Wei, 1983; Broffman & McCulloch, 1986; Tiller, 1982). These devices

and their associated techniques have not become an accepted part of

conventional medicine for three major reasons: l) the techniques are often

unreliable (Kenyon, 1984); 2) no body of scholarly research exists

demonstrating their effectiveness; 3) the metaphysical theory upon which

these devices are based is untenable to most Western health professionals.

Although several recent studies have supported the efficacy of this

technology (Tsuei, Lehman, Lam, & Zhu, 1984; Sullivan, Eggleston,

Martinoff, & Kroening, 1984), none have appeared in major medical journals.

An evaluation of both traditional and electronic pulse-taking techniques

was undertaken in this dissertation research. The aim was to: 1) assess the

validity of Traditional Chinese pulse diagnosis; 2) determine if electronic

devices can be used to increase the accessibility (with respect to

requisite training) of this diagnostic method; 3) assess whether

Traditional Chinese pulse diagnosis can be used to help integrate the dual

health care system in San Francisco. Significant positive results would

place Traditional Chinese medicine on a stronger scientific footing and

suggest a greater role for Traditional Chinese medicine in the orthodox

medical system in San Francisco.

Investigation of Traditional Chinese Pulse Diagnosis

Subjects

Ten subjects from On Lok Senior Health Services in San Francisco

participated in this study of Traditional Chinese pulse diagnosis. These

subjects were recruited on the basis of the contents of their medical file

at this center; a medical file was considered appropriate for the study if

it: 1) did not contain references to physical or physiological conditions

at the pulse examination area that might constitute a confounding variable;

2) did refer to such conditions at the pulse examination, but these

conditions could be controlled for.

Of particular concern was any medical file reference (direct or indirect)

to: pulse beat abnormalities, the consistency of the radial artery (e.g.;

hypertension), the physical condition of the area surrounding the wrist

area (e.g.; an overweight individual has fatter wrists), abnormal shaking

at the wrist area (e.g.; some manifestations of Parkinson's Disease), the

sex of an individual (e.g.; women generally have smaller wrist bones).

The aim was to eliminate or obscure unfair clues that could positively

influence the physicians' attempt to correctly match anonymous medical

files with subjects on the basis of pulse analysis alone.

The following selection criteria were ultimately used to select the

subjects: all subjects were female;

1. age and weight differences between subjects were minimized (the mean

age was 80.5 years old);

2. no subject suffered from skin problems at the wrist area;

3. all subjects had a history of hypertension;

4. all subjects were free of pulse beat abnormalities,

5. all subjects were free of shaking syndromes at the wrist area;

6. each subject suffered from a unique set of disease conditions (so as

to enable the physicians to distinguish one subject from another);

7. all subjects were Asian Americans.

Materials and Equipment

Medical files at On Lok Senior Health Services in San Francisco (see

Appendix E) contain comprehensive medical information on every client who

visits the center. These files are updated regularly (usually on a daily

basis) and are considered an accurate and comprehensive account of what

disease conditions plague On Lok clients at any given time. The files were

used in this investigation to verify the health condition of each subject

at the time of his/her pulse examination. The following bits of information

were deleted from each file in order to avoid any confounding variables:

name, age, height, weight, pulse rate, and blood pressure information.

An electronic pulse-taking device developed by Dr. Laub (1983), working in

conjunction with Dr. Broffman and Dr. McCulloch (1986) was used by one of

the two Traditional Chinese. physicians taking part in the study. This

device detects radial artery pulse signals at the same 18 positions

palpated by Chinese physicians thousands of years ago. Pulse images are

digitized by the device and written to disk as a computer file. Each image

can then be printed out (see Appendix D), matched with one of the 31

recognized pulse patterns in Traditional Chinese medicine (Porkert, 1983),

and used for diagnostic purposes.

Pulse Assessment Form A (see appendix B) was used in the test of pulse

diagnosis reliability. This form is divided into three main sections.

General Pulse Section

The first section (general pulse section) assesses the radial artery pulse

as it appears at three spatial locations (inch, gate, and foot) and three

depth locations (superficial, middle, and deep) in the left and right wrist

area. This assessment is general in nature and does not separate out unique

characteristics of the pulse at the various spatial and depth locations. A

total of eleven pulse categories are considered in this section. Each

category is associated with two qualitative dimensions:

1) depth: floating or deep (a floating pulse is found in the upper region

of a pulse position while a deep pulse is found in the bottom region);

2) intensity: strong or weak (a strong pulse refers to a forceful beat

while a weak pulse refers to a delicate beat);

3) amplitude: big or small (a big pulse refers to a large stroke while a

small pulse refers to a short stroke);

4) frequency: fast or slow (a fast pulse refers to frequent beats while a

slow pulse refers to infrequent beats);

5) rhythm: rhythmic or arrhythmic (a rhythmic pulse refers to uniform

cycles of the pulse while an arrhythmic pulse refers to irregular cycles);

6) length: long or short (a long pulse has a wide base while a short pulse

has a thin base);

7) type: yang or yin (a yang pulse is characterized by an expanded pulse

while a yin pulse is characterized by a deflated pulse);

8) temperature: hot or cold (a hot pulse is associated with an energetic

pulse rate while a cold pulse is associated with a lethargic pulse rate);

9) quantity: shih or cold (a shih pulse contains a large amount of energy

while a cold pulse contains a small amount of energy);

10) texture: hard or soft (a hard pulse is characterized by a pointed top

while a soft pulse is characterized by a round top);

11) width: wide or thin (a wide pulse has a large peak while a thin pulse

has a narrow peak).

Sub Pulse Type Section

Section two (sub pulse section) provides for a more detailed analysis of

four of the eleven pulse categories in section one (depth, intensity,

amplitude, and frequency). Depending on what decisions were made in this

prior section, each physician chooses from among the pertinent "Sub 1" and

"Sub 2" qualitative dimensions described below:

1) For floating pulses: simple, flooding, or none (sub 1) and soft,

bowstring hollow, leathery, or none (sub 2)

2) For deep pulses: simple, hidden, or none (sub 1) and weak, prison, or

none (sub 2)

3) For either strong or weak pulses: full, feeble, thready, or none (sub 1)

and slippery or none (sub 2)

4) For either big or small pulses: long, short, or none (sub 1)

5) For slow pulses: simple or none (sub 1) and knotted or none (sub 2) For

fast pulses: simple or none (sub 1) and rapid, agitated, or none (sub 2)

Individual Pulse Section

The third section of Pulse Assessment Form A (individual pulse section)

describes the pulse as it is found at each of the three spatial locations

(inch, gate, and foot) at the left and right wrist area. The same eleven

pulse categories are used to analyze these six spatial locations. The

various depth location findings (superficial, middle, and deep) at each

spatial location are taken into account in this assessment:

1) depth: floating or deep;

2) intensity: strong or weak;

3) amplitude: big or small;

4) frequency: fast or slow;

5) rhythm: rhythmic or arrhythmic;

6) length: long or short;

7) type: yang or yin;

8) temperature: hot or cold;

9) quantity: shih or cold;

10) texture: hard or soft;

11) width: wide or thin

Assessment Form B (see Appendix C) was used in the assessment of pulse

diagnosis validity. This form allowed each physician three opportunities

(1st, 2nd, & 3rd choice) to correctly match a given medical file (coded A

through J) with a given pulse (Coded 1 through 10). The level of certainty

associated with each attempted match was indicated by the attachment of one

of three symbols (* = confident, + = fairly sure, - = doubtful) to each

proclaimed match.

Procedure

In August of 1988 data collection for the pulse analysis component of the

study was completed at On Lok Senior Health Services in San Francisco. Ten

subjects were examined by two Traditional Chinese physicians; one using the

Traditional hand palpation method and the other using a computer assisted

electronic device.

The two Traditional Chinese physicians were selected on the basis of their

extensive experience using this form of diagnosis and the fact that one of

them (Dr. McCulloch) used an electronic method of pulse diagnosis (Broffman

& McCulloch, 1986).

The two physicians examined the pulse of the same 10 subjects and attempted

to: 1) obtain the same pulse readings on a given subject (a test of the

reliability of pulse diagnosis); 2) correctly match subjects with their

corresponding medical files on the basis of pulse analysis alone (a test of

the validity of pulse diagnosis).

The two Traditional Chinese physicians administered their respective pulse

examinations over the course of a single day in a specially prepared room

at On Lok Senior Health Services.

Three precautions against experimenter bias were observed: 1) the subjects

sat behind a screen with only the diagnostically relevant area of their

wrists visible to the two physicians (a special glove was worn) 2) no

contact was allowed between the two examining physicians at any time during

the study; 3) the pulse examination schedule was altered in the middle of

the day in order to avoid any detectable patterns. All pulse examinations

were timed by the research assistant.

The matching of the ten medical files to the two sets of pulse profiles

(one traditional set and one electronic set) occurred after all pulse

examinations had been completed. The physicians were given as much time as

needed to fill in the two assessment forms, and were allowed to consult any

resource materials. The assessment process took each physician

approximately two hours.

Data Analysis

Reliability of Pulse Diagnosis

The following hypotheses were constructed to test the extent of correlation

(reliability) between Traditional pulse readings and electronic pulse

readings:

H(0) = matches between Traditional pulse readings and electronic pulse

readings are the result of chance alone; there is no evidence to suggest

that Traditional Chinese pulse-taking is reliable.

H(1) = matches between Traditional pulse readings and electronic pulse

readings are not the result of chance alone; there is evidence to suggest

that Traditional Chinese pulse-taking is reliable.

An exact correspondence between how Dr. Broffman evaluated a given pulse

category for a given subject and how Dr. McCulloch evaluated the same

category was considered a match in all three sections of Assessment Form A.

The normal approximation to the binomial (Parzen, 1960, p. 239) was

employed to determine whether the results obtained (or more extreme

results) were better than chance alone would normally produce. The

probability of at least x matches is the sum of the binomial probabilities

[x + (x + 1) + (x + 2) ...] which can be approximated by a normal

distribution. A probability value of <.05 was considered significant.

The percentage of correct matches in all three sections were calculated as

an additional way to assess the reliability of the two methods of pulse

analysis. The results for the three sections were as follows:

87 matches of a possible 110 matches, 24 (79% of possible matches) were

achieved in the general pulse assessment section. The probability of this

result or more extreme results occurring by chance alone is p< .0001.

In the sub pulse section:

4 out of 5 possible matches (80% of possible matches) were achieved in the

depth/sub 1 category (p=.023 for 4 or more matches);

1 out of 4 possible matches (25% of possible matches) were achieved in the

depth/sub 2 category (p=.52 for 1 or more matches);

2 out of 7 possible matches (29% of possible matches) were achieved in the

intensity/sub 1 category (p=.56 for two or more matches);

1 out of 2 possible matches (50% of possible matches) were achieved in the

intensity/sub 2 category (p=.75 for one or more matches);

2 out of 7 possible matches (29% of possible matches) were achieved in the

amplitude/sub 1 category (p=.74 for two or more matches),

7 out of 7 possible matches (100% of possible matches) were achieved in the

frequency/sub 1 category (p=.0078), and

7 out of 7 possible matches (100% of possible matches) were achieved in the

frequency/sub 2 category (p=.0002).

463 matches out of a possible 660 matches (70%) were achieved in the

individual pulse section (p< .0001 for 463 or more matches).

(Note: Possible matches in the general pulse section is equal to the number

of subjects (10) multiplied by the number of choices per subject (11) on

Assessment Form A. Possible matches in the individual pulse section is

equal to the number of subjects (10) multiplied by the number of choices

per subject. Possible matches in the sub pulse section is equal to the

number of subjects for whom a match occurred in a previous pulse assessment

stage: 1) the number of matches in the depth, intensity, amplitude, and

frequency main pulse categories became the possible match numbers for

corresponding Sub 1 responses; 2) the number of matches in the sub 1 pulse

category became the number of possible matches for corresponding sub 2

responses. The decision not to examine results in cases where no match was

achieved in a previous section was made in order to simplify interpretation

(i.e.; if a general interpretation of the pulse is disparate as reflected

in a no match, the interpretation of a corresponding lower level match

(which represents a finer look at this general assessment) is unclear.)

Validity of Pulse Diagnosis

Western medical theory contends that palpation of the radial artery pulse

at the right and left wrist areas can not reveal diagnostic information

about the stomach, lungs, pancreas, gall bladder, etc. as claimed by

Traditional Chinese physicians. The following hypotheses were constructed

to test this contention:

H0 = correct matches between medical files and pulse profiles are the

result of chance alone; there is no evidence to suggest that Traditional

Chinese diagnosis is valid.

H1 = correct matches between medical files and pulse profiles are not the

result of chance alone; there is evidence to suggest that Traditional

Chinese diagnosis is valid.

Pulse/medical file matching results were considered significant in this

study if the probability of occurrence by chance alone was <.05. The

results were as follows:

Dr. Broffman used the hand palpation method to achieve two correct 1st

choices (p= .264 for two or more 1st choice matches to occur by chance

alone), one correct 2nd choice (p= .322 for three or more 1st & 2nd choice

matches to occur by chance alone), and three correct 3rd choices (p=.047

for six or more 1st, 2nd, & 3rd choices to occur by chance alone). Dr.

McCulloch used a computer assisted electronic device to achieve two correct

1st choices (p= .264 for two or more 1st choice matches to occur by chance

alone).

Discussion

Introduction

Several methodological approaches were considered in this investigation of

Traditional Chinese pulse diagnosis; a design in which: 1) both Traditional

Chinese physicians used hand palpation methods; 2) both Traditional Chinese

physicians used electronic pulse detection methods; 3) one physician used

the hand palpation method and the other used the electronic pulse detection

method.

The first two alternatives were rejected in favor of the third for two

major reasons: 1) testing an electronic device was an essential part of

this research 25 2) only one experienced electronic device operator was

available in the San Francisco Bay area. It should be noted that the

results achieved for the chosen approach (palpation/electronic) do not

necessarily suggest what levels of validity and reliability would have been

achieved had one of the other two approaches mentioned above

(palpation/palpation; electronic/electronic) been used in the study.

In other words, a low reliability finding in this investigation would not

rule out the possibility that a high level of reliability could have been

achieved if the electronic/electronic approach had been used. Lack of

reliability in this investigation could be explained in any of the

following eight ways:

1) electronic assessments of the pulse are accurate but hand palpation

assessments are not as a consequence of improper palpation technique;

2) electronic assessments of the pulse are accurate but hand palpation

assessments are not as a consequence of faulty interpretation of pulse

findings; 3) hand palpation assessments of the pulse are accurate but

electronic assessments are not as a consequence of improper sensor

placement;

4) hand palpation assessments of the pulse are accurate but electronic

assessments are not as a consequence of faulty equipment;

5) hand palpation assessments of the pulse are accurate but electronic

assessments are not as a consequence of faulty interpretation of pulse

findings; 6) both electronic and hand palpation assessments are inaccurate

as a consequence of improper measurement techniques;

7) both electronic and hand palpation assessments are inaccurate as a

consequence of faulty interpretation of pulse findings;

8) both electronic and hand palpation assessments are inaccurate as a

consequence of pulse diagnosis being nothing more than an artifact;

A high level of reliability in the chosen palpation/electronic approach,

however, does suggest that a high level of reliability would have been

achieved if the electronic/electronic approach had been used.

Significant Results

In both the first section (general pulse) and third section (individual

pulse) of Pulse Assessment Form A the physicians achieved a significant

p<.OO01 result (79% and 70% of possible matches respectively). These

sections dealt with: depth, intensity, amplitude, frequency, rhythm,

length, type, temperature, quantity, texture, and width measurements of the

pulse.

In section two (sub pulse section) a significant p=.023 result (80% of

possible matches) was obtained in the depth/sub 1 pulse category; a

significant p=.0078 result (100% of possible matches) was obtained in the

frequency/sub 1 pulse category; and a significant p=.0002 result (100% of

possible matches) was obtained in the frequency/sub 2 pulse category.

No significant findings were obtained in the remaining four categories

(depth/sub 2, intensity/sub 1, intensity/sub 2, amplitude/sub 1), which

represented 25%, 29%, 50%, and 29% of possible matches respectively.

The above findings suggest that pulse diagnosis reliability goes down as

more subtle levels of distinction are attempted.

Other results suggest that there may be some validity to Traditional

Chinese pulse diagnosis; in the pulse/medical file matching effort Dr.

Broffman was able to achieve a statistically significant result (p<.047)

for six or more correct 1st, 2nd, & 3rd choices. However, this conclusion

must be tempered in light of the fact that a methodological problem was

encountered which may have influenced the results. One subject with

Alzheimer's Dementia behaved in a way that may have confounded the results

of the subject/medical file matching effort. This subject was observed to

"mumble to herself" (suggesting a mental condition) and forcefully wiggle

her arms (suggesting resistance) on numerous occasions during the

examination process. These two bits of information could have been used as

additional clues in the matching selections made by the two physicians (a

person with a mental condition such as Alzheimer's Dementia would be more

likely to mumble and/or be resistant to the examination procedure than a

person without this condition).

It must be pointed out that although this additional information was

available to the two physicians, there is no evidence that they took the

information into account in their selection process. The fact that both Dr.

Broffman and Dr. McCulloch achieved correct 1st choice matches on this

subject could be purely coincidental and have nothing to do with a

confounding variable. A second analysis was made in which the subject in

question was not factored into the results. The highest probability under

these circumstances was p<.l5.

It also questionable whether the use of second and third choice selections

in the determination of statistical significance is a viable methodological

approach. The fact that a statistically significant result was obtained

only after second and third choice selections were taken into account may

indicate an inherent lack of precision in Traditional Chinese pulse

diagnosis that limits its clinical usefulness.

An alternative explanation links this seeming diagnostic imprecision to

incomplete symptom recording in On Lok medical files rather than any

inherent weakness in Traditional Chinese pulse diagnosis. Often symptoms

that are useless from a Western medical point of view can be the key that

unlocks a diagnosis in Traditional Chinese medicine. For example, chronic

canker sores helps in the diagnosis of a heart condition in Traditional

Chinese medicine.

Minor symptoms such as this could very well be left out of Western oriented

On Lok medical files; thus putting the Traditional Chinese physicians at a

distinct disadvantage in their matching efforts. If more minor symptoms had

been recorded in On Lok medical files the two physicians may have achieved

better results.

(Note: A one out of three correct rate is not deemed acceptable by most

physicians (Western as well as alternative practitioners) and patients,

suggesting that only first choice selections should be included in a test

of pulse diagnosis validity.)

The physicians may also have fared better if they been Western-trained

physicians in addition to being experts in Traditional Chinese medicine.

Neither their prior training nor currently available resource books

afforded them much help in accurately translating Western disease

conditions into Traditional Chinese nomenclature; a process which was vital

to the achievement of good results.

The fact that the physicians did not have extensive experience diagnosing

very old individuals (the mean age of the subjects was 80.5) who suffered

from so many acute and chronic disease conditions may have been another

impediment to their success. It also should be noted that Traditional

Chinese physicians typically cross-check pulse diagnosis findings with

other physical indicators in the body such as the tongue.

When contradictory findings are found at any of these other sites the pulse

profile is reexamined and any errors are corrected. This recovery process

could render Traditional Chinese pulse diagnosis a useful diagnostic method

even if the technique and/or its implementation is less than perfect. Had

the physicians been allowed to look at each patient's tongue as well as

examine her pulse they may have achieved better results.

Conclusion

More investigation of Traditional Chinese pulse diagnosis is needed before

any definitive statement can be made about the reliability and validity

associated with its use. Although the results of this preliminary

investigation suggest that there may be some scientific basis for this

ancient technique, its reliability needs to be substantially improved in

key areas of the diagnostic process. As discussed earlier, it is unclear

whether low reliability findings in this study are the result of operator

error, faulty equipment, or improper interpretation of pulse findings.

One of the key findings in this investigation was that the complex nature

of traditional hand palpation virtually rules out its effective use by

Western physicians in San Francisco; accurate pulse assessments by

individuals who have only a superficial training in Traditional Chinese

diagnostic techniques is not a realistic objective.

The electronic pulse-taking device, however, does appear to hold great

promise even though it did not successfully demonstrate its diagnostic

capabilities in the test of pulse diagnosis validity. The positive results

achieved in the general and individual sections of Pulse Assessment Form A

(the test of reliability) suggest that further refinements in this

technique could eventually lead to an effective and easy to use tool for

pulse diagnosis in a more integrated dual health care system in San

Francisco.

Although pulse diagnosis basics (i.e.; hard versus soft pulse) can be

learned in a relatively short period of time, the detection and

interpretation of more subtle pulse forms are needed in order to perform an

accurate and comprehensive diagnosis.

The fact that that the electronic device is interfaced with a PC computer

holds open the possibility that a partially or completely automated system

of interpreting pulse patterns (according to the thirty recognized wave

forms in Traditional Chinese medicine) could be developed.

Efforts in this direction are already being made, and preliminary results

are encouraging. This would substantially reduce the training needed to

operate a device and shorten pulse administration and interpretation time

to approximately 10 minutes.

With the addition of this feature, Traditional Chinese pulse diagnosis

could become: 1) highly accessible to Western physicians in San Francisco;

2) an effective means of helping bridge the gap between Western and

Traditional Chinese systems of medicine in San Francisco.

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Questions, comments, or requests may be addressed to: Michael McCulloch,

L.Ac. or Michael Broffman, L.Ac. at chinamed@well.com

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