|
The concept of
constitutional pulse taking
In constitutional medicine taking the pulse is very
important the same as in traditional Chinese medicine. But constitutional pulse
taking differs from traditional pulse taking by aim, location, and method, so
is regarded as a completely different type of pulse taking.
The biggest difference
is that the traditional pulse taking is used to find the state and cause of
illness, while constitutional pulse taking is used to find the constitution of
a person. Constitutional pulse taking is the most important method of
determining a person's constitution.
Constitutional pulse is not linked to a lot of different diseases of the human
body and is always an unchanged and regularly beating pulse, in contrast to the
general pulse that changes in each moment. Therefore, constitutional pulse
taking is less complicated and easier to learn than traditional pulse taking.
One can relatively easily become skillful through training. Once you attain a
certain level, each pulse taking brings the same result. For that reason,
constitutional pulse taking can be called epoch making pulse taking with clear
reproducibility.
Taking the pulse and
attributing it to the organs
Wang Shuhe, author of Maijing, divided the pulses into the
three regions of cun, guan and chi for each hand and
attributed them respectively to the five zang organs and the six fu
organs, and observed abnormal syndromes of the organs. As shown in illustration
25, there is a defined principle among the organs which correspond to their
respective pulse regions.
The lungs correspond to the right hand region cun and deliver oxygen to
the body. The pancreas corresponds to the right hand region guan and
digests food and delivers nutrition. The vital gate corresponds to the right
hand region chi and delivers hormones. The heart corresponds to the left
hand region cun and distributes blood to the whole body. The liver
corresponds to the left hand region guan and by absorbing eliminates
toxins. The kidneys correspond to the left hand region chi and excretes
waste. So the organs corresponding to the right hand deliver materials while
those corresponding to the left hand utilize them.
Illustration. The regions cun, guan and chi for both hands
If we look at the relationships between the organs attributed to
the regions cun, guan and chi of both hands, we can see
that between them there is a relationship of mutual generation and subjugation
of the five elements: water, wood, fire, earth, and metal. The kidney of the
left hand region chi is water and generates wood (liver) of guan.
This wood (liver) generates fire (heart) of cun. So there is that kind
of relationship of mutual generation, where water generates wood and wood
generates fire.
Fire (heart) of the left hand region cun is linked to fire (vital gate)
of the right hand region chi. This fire (vital gate) generates earth
(pancreas) of guan, and this earth (pancreas) generates metal (lungs) of
cun. So there is the kind of relationship of mutual generation in which
fire generates earth, and earth generates metal. Metal (lungs) of the right
hand region cun generates water (kidneys) of the left hand region chi.
In that way this mutual generating works unceasingly.
On the other hand, fire (heart) of the left hand region cun subjugates
the metal (lungs) of the right hand region cun, wood (liver) of the left
hand region guan subjugates earth (pancreas) of the right hand region
guan, and water (kidneys) of the left hand region chi subjugates
fire (vital gate) of the right hand region chi. So there is a
relationship of mutual subjugation, such that the organs attributed to the left
hand subjugate those attributed to the right hand.
In other words, it is generally known that the left hand pulse is
stronger than that of the right hand, because the left hand is stronger than
the right hand, which is ruled by the left hand.
In Yixue Rumen it is written:
"The left hand belongs to yang and the right hand to yin. The heart in
the left hand region cun is king-fire and so is noble and above others, while
the vital gate of the right hand region chi is subject-fire and so is not noble
and below others. They form the order of king and subject."
Illustration. Relationships of mutual generation and subjugation in the pulses of the two
hands.
At first one might think that observing the state of the organs at
the three pulse regions cun, guan and chi is baseless, but
with experience it is an undeniable evident fact.
Chinese medicine divides the body into three jiaos, unlike the Korean
constitutional medicine which divides it into four jiaos. Chinese medicine
attributes the organs of the three jiaos to the regions cun, guan
and chi and diagnoses their insufficient or excessive syndromes.
Let's look more closely at the theoretical background of the attribution of the
organs. In Huangdi Neijing there is the following sentence:
"Illness of the chest or throat is diagnosed at the upper region and
that of the lower abdomen, waist, thighs, knees, legs and feet at the lower
region."
Huangdi Neijing divides the human body into the upper, middle, and lower
parts and attributes the upper part to the region cun, the middle part
to the region guan and the lower part to the region chi. So this
attribution is based on a spacial concept of upper, middle, and lower.
In the 18th chapter of Nanjing (The Classic of Difficulties) it is
written:
"There are the three regions and nine positions of pulse. What do they
rule respectively? The three regions are cun, guan and chi.
The nine positions signify surface, middle, and deep. The upper region
corresponds to heaven and rules diseases of the chest and head. The middle
region corresponds to humans and administers diseases of the lower chest to the
navel. The lower region corresponds to the earth and rules diseases of the
navel to the feet."
The whole human body is divided into three parts and attributed. The region
cun reflects all the diseases of the upper body from the chest to the head.
The region guan reflects all diseases of the middle body from the lower
chest to the navel. The region chi reflects all diseases of the lower
body, namely the lower abdomen, waist, thighs, knees, legs and feet. If we
limit that to the trunk, it can be divided into the three parts chest, lower
chest and belly. So it's natural that the five zang organs and the six
fu organs can be attributed to the three jiaos by position.
Illustration
27. Attribution of the five zang organs to the six pulse regions
The attribution of the five zang organs to the six pulse regions
is generally accepted, but that of the six fu organs differs in the various
classics and schools.
Wang Shuhe attributes the small intestine, gall bladder
and bladder together with the heart, liver and kidneys respectively to the left
hand regions cun, guan and chi, and the large intestine,
stomach, and three jiaos together with lungs, pancreas and the vital gate
respectively to the right hand regions cun, guan, and chi.
Lungs and large intestine correspond to metal; heart and small intestine
correspond to fire. They are respectively brotherly organs of yin and yang and
so are attributed to the same pulse regions. Similarly, liver and gall bladder,
pancreas and stomach, kidneys and bladder respectively are attributed to the
same pulse regions.
But Zhang Zhongjing, a famous ancient Chinese doctor, criticized his
attribution, saying:
"Wang Shuhe says that heart and small intestine correspond to the left
hand region cun, lungs and large intestine correspond to the right hand region
cun. But to followers, that has shown to be an evident error. Large intestine
and small intestine are organs of the lower part, so they certainly must
correspond to the region chi of the two hands."
Like Zhang Zhongjing, Li Shizhen in his book Binhu
Maixue and Wu Qian in the book Yizong Jinjian attribute both
intestines not to the cun region, but to the chi region. They
think that since the two intestines anatomically belong to the lower part of
the body, they correspond to the chi region. They say that is the
principle of the pulse, which follows the concept of upper and lower mentioned
in Huangdi Neijing and Nanjing.
Lee Jema divided the human body into the four jiaos and attributed kidneys and
large intestine to the lower jiao. His attribution better conforms to the real
facts observed in clinical practice than that of Wang Shuhe.
For example, diseases of the large intestine such as diarrhea or constipation
are felt not at the right hand region cun, but in fact on the right hand
region chi. Also, abnormal syndromes of the organs attributed to the
upper, middle, and lower jiaos appear respectively at the pulse regions upper,
middle, and lower. This indeed conforms to the principle of attributing the
organs to pulse regions.
However, Wang Shuhe did his attributing not based on clinical experience, but
on deductive reasoning following meridian theory, becoming lured away from fact
by ideas. So for him such criticism is inevitable.
|
