The Art of Feeling the Pulse
Tibetan Pulse Diagnosis
Research on the automation of Oriental diagnostic methods is current in France, South Korea, China, Japan, Taiwan and Russia. Pulse diagnosis is of particular interest in this regard and the resolution of technical problems in the design of pulse sensors is a primary focus of all such projects.
Beginning in 1983 a project to develop an objective and automated version of the diagnostic techniques of Tibetan medicine was undertaken at the Laboratory of Radiobiophysics (LRBPh) of the BINS of the Russian Academy of Sciences (RAS) under the guidance of Dr. Chimit Tsyrenovitch Tsydypov.
This is a high-priority programme whose distinctive feature is its inter-disciplinary approach. The first component is an in-depth study of original Tibetan medical texts, in particular those on pulse diagnosis.
To briefly review the basic concepts underlying Tibetan pulse diagnosis: In the Buddhist world-view all matter is composed of the "five great elements" (Sk. panchamahabhuta, Tib. 'byung ba lnga): earth, water, fire, air/wind and space. Contributions of these elements determine the pulsation in each human organism. They also form three principles of physiologic regulation which are called nyes pa gsum, literally "the three faults", more generally translated as "the three humours" or "essences". The investigation of the different types of pulse traditionally associated with each of these elements and humours, and their relationship to external and internal factors, is fundamental to our research.
Tibetan medical classics provide graphic descriptions of the various types of pulses to be recognised.
The second component of our research is to automate this traditional diagnostic skill. Ours is a multi-faceted approach, which seeks to compare the waveforms of pulses felt at several sites along each radial artery and to interpret these as data about the different organs and physiologic systems. This entails numerous mathematical and technical problems.
The frequency and strength of a pulse, its fullness, the discrimination between strong and weak pulses, and the nature of any variation in rhythm must all be taken into account. We hope to record all of these parameters with the help of modern equipment. The subsequent processing and deciphering of pulse signals will make it possible to translate the different types of pulses which are described in the Tibetan texts into measurable parameters - the language of modern science. This will make possible the correlation of pulse abnormalities with particular dysfunction or diseases.
The development of an objective methodology for the differentiation of pulse types also entails difficulties. We need mathematical models of the pulse wave and methods to analyse and interpret them. The movement of the blood in the vessels is a complicated hydrodynamic process, the study of which is impossible without mathematical models of biological systems (MMBS). The state of health of a patient is assessed using values determined by these mathematical models, and the effectiveness of computer applications in medical diagnostics depends on their adequacy. Current techniques of MMBS appear to be inadequate to our task. In particular MMBS’s based on linear theories of pulse wave transmission in the artery are of insufficient accuracy for our application.
An expert computer programme for the practical application of Tibetan medical knowledge (known as 'Emchi') is being developed. This will take into account not only pulse data but also the outer main diagnostic methods of Tibetan medicine - questioning of the patient and visual examination of tongue, urine, etc. This system will be able to diagnose and prescribe on the basis of Tibetan medical principles. As of the present the relationship between the physical and physiological parameters of these pulses and the traditional Tibetan ways of interpreting them have still not been sufficiently investigated. A better understanding of this is of key significance to understanding the theory and practice of Tibetan medicine as a whole and to the automation of diagnosis.
Another problem related to the diagnostic interpretation of the pulses is the identification of the physical and physiological mechanisms through which the traditional zones of palpation on the radial arteries are connected with the internal organs. This issue is complicated by the fact that the palpation zones are different for men and women.
At this stage of our research we have already developed equipment to record pulse waves at the six traditionally specified locations on the radial artery and to analyse and interpret the resulting "pulsograms." In the near future we wi ll concentrate on improving the diagnostic capabilities of the system. Our goal is to develop a diagnostic device, which will work effectively under clinical conditions.
In addition to the above, we are also working on an objective approach of electrometric diagnosis using the "Biologically Active Points" (BAP) of Tibetan and Mongolian medicine (TMM). These are located all over the body. Tibeto-Mongolian locations of these points are not synonymous to those of Chinese medicine. Tibetan and Mongolian medical cultures do not mention meridians, and their diagnostic methods also differ from those of the Chinese. It seems to be necessary to investigate the connections between the BAP and the inner organs or functional systems which are specified in each of these medical systems.
In summary the objectives of our research are the following:
- To determine the precise meaning of the central physiological concepts of Tibetan medicine, i.e. the three nyes pa: rlung ("wind"), mkhris pa ("bile") and bad kan ("phlegm");
- To systematically catalogue the different types of pulses;
- To develop mathematical models of the pulse waves and methods of deciphering them;
- To clarify the relationship between the palpation zones on the physician's fingertips, those on the patient's wrist and the internal organs, as well as that between the BAP and the internal organs;
- To create, based on this knowledge, an integrated, computerised diagnostic system.
The resolution of these problems will facilitate a realistic assessment of the achievements of Tibetan diagnostics and therapeutics, and the development of scientifically based applications of Tibetan medicine. It will also be a valuable contribution to our appreciation of Indian and Tibetan cultures and Buddhist thought.
Our current research activities are in three areas:
- Compiling databases and expert programmes for Tibetan and Mongolian medicine;
- Extracting and cataloguing scientific data to support automated diagnosis. This includes the cataloguing of pulses.
- Investigating the mechanism of the connection of palpation zones with the internal organs and/or functional systems.
- Collecting scientific data on the Biologically Active Points (BAP). Two or three groups of the BAP specified in Tibeto-Mongolian medicine will be objectively analysed. As a result of this work, electropunctural methods for the diagnosis of diseases will be proposed.
We estimate the project can be completed within five years. As the proceeding summary has made clear, it incorporates linguistic, mathematical and experimental methods, making use of an automated system for Tibetan pulse reading, an expert diagnostic programme, and specialists in sphygmology. The latter stages of research will be carried out in collaboration with the Republican Hospital of the War Invalids of the Ministry of Health of the Republic of Buryatia.
- Philosophic, medical and physical interpretations of the five elements (Tib. 'byung ba lnga, Sk. panchamahabhuta) and the three physiological principles (Tib. nyes pa gsum).
- More adequate mathematical modelling of the pulse waves, which will allow the analytic differentiation of pulses traditionally taken to be indicative of disturbances of the three nyes pa, of heat and cold, and of blood.
- An expert system for diagnosing diseases, using Tibetan methods. This will include pulse diagnosis, questioning of patients and physical observations.
- A new approach to the comprehension of Tibeto-Mongolian medical texts will allow the creation of an on-going diagnostic system capable of refining and improving itself automatically.
References (in Russian)
- PUPYSHEV V.N.: Tibetskaya meditsina: yazyk, teoria, praktika. (Tibetan Medicine: language, theory, practice.) Novosibirsk, Nauka Publishers, Siberian Department, 1991, 140 pages.
- TSYDYPOV, CH. TS. (ed.): Pulsovaya diagnostika tibetskoi mediciny / Sbornik statei pod red. d.f.-m.n. (Pulse diagnosis in Tibetan Medicine. Collection of articles edited by Prof. Ch. Ts. Tsydypov). Novosibirsk, Nauka Publishers, Siberian Department, 1988, 134 pages.
- BOROYONEV V.V., SHABANOVA E.V.: Tchislennoie diggerentsirovanie sfigmogramm lutchevoi arterii metodom regularizacii Tichonova (Numerical differentiation of the pulsograms of the wrist radial artery by the method of regularisation of Tichonov). Izmeritelnaya technika, 1994, N 11, p. 60-62.
- ZHAMBALDAGBAYEV, N. TS., ZANDANOVA G. I. : Ekspertnye meditsinskie sistemy tibetskoi meditsiny: sostoyanie i perspektivy // Tibetskaya Meditsina: sostoyanie issledovanii. (Expert Medical Systems of Tibetan Medicine: Conditions and Perspectives // Tibetan Medicine: the Level of its Research). Ulan-Ude, 1994, p.101-107.
* VITALY VASILYEVICH BORONOYEV, Ph.D. (Physics and Mathematics) is the Head of the Laboratory of Radiophysics at the Buryat Institute of Natural Sciences (BINS) Russian Academy of Sciences, Siberian Branch, Sakyanovoi Street 6, Ulan-Ude 670042, Republic of Buryatia, Russia.
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