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Feeling the Pulse, a Diagnostic Method in Tibetan Medicine

nad la blta reg dri bas yongs shes bya

This quotation from the fourth chapter of the Root Tantra (rtza ba'i rgyud), that is the first of the four main medical treatises, in Tibetan known as Gyushi (rgyud bzhi), says that illness can be understood through three principal methods of examination:

1. Visual Examination 
2. Examination by Touch 
3. Examination by Questioning

1. Visual examination focuses on signs and symptoms that a physician can observe in the patient's outer appearance and manifestations. Urine, eye and tongue analysis form a part of this method.

2. Examination by touch implies feeling the patient's body temperature, abnormal growth, etc. Tibetan pulse diagnosis, a deeply rooted method of diagnosis, special and unique, is an integral part of this examination. Mastering this art requires many years of practice under the guidance of an expert. Merely studying the chapters of pulse in the medical treatises will not be sufficient as special practical instructions are needed to comprehend the various types of pulses, their rhythms and their respective causes within the body.

3. Examination by questioning touches upon three areas: 

  • Tracing back the cause of disease, that may lie in unwholesome food and unbalanced behaviour, etc.
  • Asking for signs and symptoms.
  • Asking for effects and changes during the process of medical treatment

The Relationship between Illness, Pulse and the Physician

nad dang sman pa brta sbyar 'phrin pa rtza

"The pulse is the messenger between the disease and the physician.", we read in the first chapter of the Last Tantra (phyi ma'i rgyud) of the Gyushi. For a physician, pulse reading is the most essential diagnostic method. Yet, to know the nature of diseases, the physiological constituents (lus zungs) and essentials on 'positive health' are equally important for the understanding of pulse diagnosis. The variations in pulse rhythm and quality depend on the interdependence of three basic factors:

1. the three humours Lung (rlung), Tipa (mkhris pa) and Bakan (bad kan) - their literal meaning is "faults" (nyes pa); 
2. the seven body constituents (lus zungs bdun); 
3. the three excrements (dri ma gsum).

These factors are basic for the development, maintenance and final destruction of the physical body. In case any of these three nyes pa derails from the path of equilibrium, either through exposure to extreme climatic conditions , inappropriate diet or mental stress, etc., they will turn into the "faults", causing physical and mental imbalance, influencing in the process the nature of the pulse.

Even minor changes in the state of equilibrium will affect the pulsation. Yuthog Yontan Gonpo, Tibet's foremost physician of the 12th century wrote that the rhythm of the pulse resembles the hands of a dancer, having no certainty whatsoever, varying from pose to pose. Thus the pulse varies throughout the changes of life's transitions and movements.

Pre-conditions for Pulse Reading 

Even a skilled physician has to observe some pre-requisites prior to feeling the pulse. Both, doctor and patient have to avoid intoxicants, excess of food and beverages, physical exertion, stress and inappropriate behaviour. The pulse should be felt at a time when the body is not strongly affected, either by hot solar or cold lunar powers. The physical and mental state of the physician should be balanced and not distracted by illness or any other condition that will divert and affect his concentration. 
lta ba, the Tibetan verb used for "feeling" the pulse also means one-pointed contemplation on a single object. (ed.)}

The physician should have regular contact with his patient, to be aware of the patient's healthy constitutional pulse, without which pulse diagnosis at the time of his illness might lead to erroneous interpretations. Climate and seasons influence the nature of the pulse for they have a deep impact on our physical conditions. Seasonal pulse rhythms can easily be mistaken for an imbalanced pulse. Even the climatic condition of the area where pulse diagnosis is conducted, as well as the constitutional nature and age of the patient are factors that are of significance to pulse diagnosis.

Tibetan pulse diagnosis is an art that cannot be easily understood or acquired. Even the above explanations are just a drop in the ocean of the vast knowledge on Tibetan sphygmology.

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The Art of Feeling the Pulse, Research on Tibetan Pulse Diagnosis

Feeling the Pulse, a Diagnostic Method in Tibetan Medicine

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