Acupuncture (AP) in Traditional Chinese Medicine (TCM)
GENERAL CONCEPTS (4/7)
Michel_W (1993) [Early Western observations of moxibustion and AP]. Sudhoffs Arch Z Wissenschaftsgesch 77(2):193-222. Inst of Languages and Cultures, Kyushu Univ, Fukuoka-City, Japan. Earlier research has maintained that the earliest passage of written information about AP and moxibustion to Western Europe took place around the middle of the 17th century. But an investigation into the letters, "historias", dictionaries, grammars etc. of the Jesuit mission in Japan, which started in 1549, shows that the missionaries there already enjoyed a considerable knowledge of both methods of treatment. These sources also reveal indications of the use of needles and moxa on horses as well as the use of "hammer-needles", a Japanese invention which was later described in detail by Willem ten Rhijne and Engelbert Kaempfer. Also some central Sinojapanese terms of anatomy, physiol and pulse diagnosis in the light of their European interpretations, and a hitherto unknown outline of Japanese medicine found in an early French book on the Chinese Pulses are presented.
Partington_M (1992) Avian AP. Probl Vet Med Mar 4(1):212-222. In both ancient and present-day China, avian AP has been used in domestic fowl kept as food animals only. For the progressive western veterinarian, there is a place for AP as a complement to the practice of conventional avian medicine. The nature and origin of the class Aves render them more responsive than mammals to traditional AP techniques. When AP is appropriately applied, the response is positive and rewarding. A working familiarity with avian anatomy and taxonomy is a prerequisite to location and manipulation of avian points. A descriptive text of currently documented avian AP points is presented.
Partington_M (1995) AP and TCM. Proceedings 16th Annual Conference Mid-Atlantic States Assoc of Avian Vets, 119-125 and Avian AP. Ibid 127-155.
Smith_A1 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 1. Adapted from WWW. [Reproduced with permission from the Editor, Pacific J of Oriental Med. Andrew Smith MEd BA(Mil) DipAc. Details are contained in the author's M Educ Thesis (1993), Univ of Canberra: Pulse Diagnosis in Traditional AP: WebMaster].
TCM Pulse Diagnosis was examined in a sample of 100 patients randomly selected from the author's AP clinic. Patients' symptoms, the TCM Pulses, diagnostic criteria (pertaining to Five Phases), AP points selected and patients' comments after each treatment were coded into a numerical format suitable for stepwise multiple regression and cross-tabulation analysis.
The analysis indicated that the interpretation of pulse qualities, from which the treatment protocol was based, predicted the diagnostic criteria when used in accordance with the theories pertaining to AP. Statistically, the selection of AP points could not be predicted from the diagnostic criteria when using Pulse Diagnosis. Also, the analysis indicated that the patient's comments after AP were independent of the initial patient symptoms.
More research is needed to fully understand the process of Pulse Diagnosis. However the analysis suggests that Pulse Diagnosis should be incorporated into AP curricula in both traditional AP courses and Med AP courses.
INTRODUCTION.
Traditional AP utilises Pulse Diagnosis as one of the "4 methods of examination" when establishing information about a patient's signs and symptoms (NH&MRC 1989; Maciocia 1991; Kaptchuk 1983). Within the author's clinic, the subsequent selection of points to treat those symptoms is mainly based upon the resulting diagnostic criteria taken from the pulses. Ultimately the process of AP used by the author is designed to stimulate the natural healing response of the patient.
The National Health and Med Research Council (NH&MRC, 1989) suggest that the education and training of practitioners are important in insuring the safety of patients receiving such care.
However debate exists as to whether Med acupuncturists, or acupuncturists versed in the TCM approach, should practise AP (Richardson and Vincent, 1989; Stephen, 1978; Hadley, 1988; Rogers, 1985b; Christie, 1991; Lewith, 1986; Rogers, 1991a). Med acupuncturists do not learn Pulse Diagnosis in their courses and generally apply what is termed "Cookbook AP" within their clinic.
Cookbook AP is generally said to be less efficacious than the very individualised approach of TCM (Ng 1978). The author considers this to be so because, without the holistic synthesis, diagnosis and treatment of TCM Syndromes, there is no adequate methodology in Cookbook AP to account for the relationships linking the symptoms, the diagnostic criteria, the points selected and the resultant patient comments at the conclusion of the AP process.
AP Education
A minimum standard of training has been recommended as being acceptable for non-Med practitioners of AP. The training course for non-Med acupuncturists, formally endorsed by the New South Wales Higher Education Board (NSWHEB) as being acceptable as a Bachelor of Applied Sci, has Pulse Diagnosis as a significant component of the AP curricula (Rogers C 1992).
AP education in Australia is offered in 2 forms and to 2 different groups (NH&MRC, 1989). Courses teach AP as a therapy or AP as a total system of health care, and, the students are either already trained and practising as health care providers or have no previous training or expertise (NH&MRC, 1989). Some courses teach AP to trainees already otherwise trained as health practitioners (NH&MRC, 1989). AP taught and practised to those medically trained is regarded as an auxiliary or adjunct to the conventional Med techniques utilised by that person.
Other courses purport to teach AP as a complete Med system (NH&MRC, 1989). These particular courses offer both basic training over a 4-yr-period as an AP therapist. In May 1987, official ratification of accreditation was granted by the NSW Dept of Educ to AP Colls (Australia) for their 4-yr AP training programme, which, at that time, was presented in conjunction with the Inst of Nursing Studies, Sydney Coll of Advanced Educ (AP Ethics and Standards Org Submission to the Minister for Health for the Registration of AP, 1988).
The emphasis of the course curricula for AP of the Univ of Technology Sydney, for example, is to teach the philosophies and techniques of AP as taught and practised in the PRC. Moreover the establishment of 2 Univ courses of traditional AP is in accordance with the recommendations of the National Health and Med Research Council (NH&MRC, 1989).
In 1987 the AP Ethics and Standards Organisation (AESO) were requested by the Peoples Republic of China to apply for membership of the World Federation of AP/Moxibustion Societies as the representatives of AP in Australia (AESO Submission to the Ministers of Health for the Registration of AP in Australia, 1988).
Each of the above teaching methodologies, that is, medical compared with traditional AP, differ in the emphasis placed on applying the traditional process of Pulse Diagnosis as a diagnostic method. The NH&MRC (1989, p66) suggested that the theoretical concepts behind traditional Chinese AP cannot be sustained scientifically. However Rogers (1991, pp151-152) suggests that scepticism and/or vested interest among the more influential members of the Med profession inhibit active promotion of AP and such procedures for many reasons: a. The public perception of professional/scientific authority would be weakened. Competent AP teachers/clinicians would have to be found raising questions as to who would be competent to select/grade them. b. Academic undergraduate curricula would have to be re-scheduled to incorporate time for AP at the expense of other course work. c. Research teams would have to recruit expert AP specialists and fund AP research in the face of a multi-national, multi-million dollar drug industry which has a powerful influence on funding of orthodox research, sponsorship of drug-related professional seminars/conferences for cooperative practitioners. d. The National Health Med/Dent/Vet hospitals, physiotherapy clinics and the general professions would have to establish AP services.
The above concerns apply equally to Vet AP which is based mainly on human AP principles (Rogers P 1991c). The choice of points for particular conditions is very similar to the choice for similar human conditions (Rogers P 1985a) hence the disagreement surrounding the diagnostic methodology to be used exists whether AP is to be used for humans or animals (Palmer R 1992).
The author has used Pulse Diagnosis as the main method of obtaining an indication of the points necessary to treat various conditions in a Primary Health Care setting. The author's use of Pulse Diagnosis is based upon the Five Phase Theory underpinning AP rather than the classic 28 pulse qualities commonly described in AP texts. It is within the context of a traditional AP clinic that the treatments have emerged.
Smith_A2 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 2.
Science or Folklore?
Much of the confusion surrounding the scientific basis of AP centres on which particular process should be utilised (Advances in AP, 1979; Pinto, 1978; Pomeranz and Stux (eds), 1989; Vincent and Richardson, 1986; Schoonover Smith, 1988; Bensoussan, 1991). That is, should the selection of AP points used to treat a particular symptom or symptoms be based on the criteria drawn from the conventional Med diagnostic procedures or from so called traditional theories?.
The debate is compounded in two ways: 1. Many versed in the "scientific method" suggest that most "scientific papers" which claimed results for AP which were statistically significant, did not satisfy the scientific method adequately. Therefore the results of many AP studies "non-scientific or largely anecdotal". 2. Acupuncturists versed in the "scientific method" suggest that most "scientific" papers which concluded that the effects of AP were not statistically different from those in placebo-Control groups were fatally flawed in their experimental design: the controls were stimulated in biologically active points with effects similar to the selected "real AP points"; thus both groups responded but there was no difference between the treatments. (In many such trials, 50-80% of subjects responded in both groups, whereas in most trials only 20-40% of subjects in negative placebo groups would be expected to respond). Therefore such trials should be reinterpreted as confirming significant clinical responses from peripheral stimulation (Rogers, unpublished). 3. Acupuncturists pursuing the TCM approach almost always respond by suggesting that the process of AP cannot be considered within the "scientific method" without compromising its holistic integrity (Chu 1979). In particular the TCM diagnostic method of Pulse Diagnosis is regarded by traditionalists as being essential to allow assessment of the patient's state of well-being (TCM Syndrome) at the time of each consultation and to dictate the most appropriate AP points to be used at that time.
The author found in clinical practice that AP point selection based on Pulse Diagnosis suggests the need to select different points for different patients who may present with similar symptoms.
It is from the subjective interpretation by the author of the iconography gained from Pulse Diagnosis, in accordance with the theories underpinning AP, that the ensuing process of AP occurs. That is, within the author's clinic, the process of AP involves the procedures of eliciting diagnostic criteria from Pulse Diagnosis, followed by the selection of appropriate AP points and, finally, determining the efficacy of the treatment. Figure 1 illustrates the process of AP utilised by the author in his statistical analysis of Pulse Diagnosis: patient symptoms and history -> Pulse Diagnosis -> Diagnostic Criteria -> AP points selected -> Patient comments after treatment.
The Process of AP
The author found through stepwise multiple regression and cross-tabulation analysis that there may be a scientific basis for using the ancient art of Pulse Diagnosis in traditional AP. Hence the author's purpose in attempting a statistical analysis of traditional AP treatments was to further the educational base for AP training programmes and to indicate the educational implications of the traditional approach to AP if introduced into the curricula of AP courses. There may be implications for incorporating Pulse Diagnosis into the design and conduct of AP courses throughout Australia and overseas. It also may influence the assimilation of AP into the primary health care sector in a way that can complement WM.
Method: Research Design
The study was an Ex Post Facto consideration of the relationship between:
a. symptoms a patient communicates (NPS);
b. diagnostic criteria (DC) as determined from Pulse Diagnosis;
c. points used for the first treatment (PUF) as determined from Pulse Diagnosis;
d. points used for the second treatment (PUS) as determined from the Pulse Diagnosis;
e. patients' comments after the first treatment (NPC); and.
f. patients' comments after the second treatment (NC).
Despite the weaknesses of Ex Post Facto research as a research method, and the limitations as described in the author's thesis, the author considered that an Ex Post Facto study was the most appropriate research design for maintaining the integrity of traditional AP and Pulse Diagnosis within the clinic setting. Other research designs such as the use of an experimental double-blind controlled study were not considered to be appropriate in this instance. The author did not want to create an artificially induced clinical environment and thereby alter the process of AP normally utilised in private practice. Central to the author's thesis was the need to study the concept of Pulse Diagnosis as a diagnostic procedure within the context of the process of AP as described.
The problem then was to indicate whether patient symptoms improved after having a course of AP using points selected from Pulse Diagnosis. The diagnostic criteria obtained from Pulse Diagnosis was considered the key to point selection and subsequent improvement in symptoms rather than the selection of AP points based on the patients' symptoms alone.
The two hypotheses tested were as follows:
Hypothesis 1: The diagnostic criteria taken from the pulses do not statistically significantly predict the AP points used in the treatment at 0.05 level of significance.
Hypothesis 2: The patients' comments after AP are independent of whether the patients' symptoms improved or not.
In formulating the hypotheses, the level of significance (p) used throughout the statistical analysis was .05. The assumptions underpinning the hypotheses were:
a. patients do not need to be of any specific gender or culture to experience improvement in symptoms;
b. patients need have no particular beliefs about AP in order to experience improvements in symptoms;
c. AP has its own philosophical foundations which, while differing from the theories and concepts underpinning the bio-Med model, have their own theories and nomenclature.
The significance of the study was to provide the basis for further research into the nature of Pulse Diagnosis and to indicate that the symptoms a patient communicates are not related to the AP points selected to treat those symptoms. Also, there were implications for AP education should relationships exist in accordance with the hypotheses, e.g. if the study suggests that Pulse Diagnosis may have a coherent basis to its application which is predicted in a scientific framework.
Procedure
100 patients' cards were randomly sampled from the author's AP clinic. All of the information pertaining to the variables under consideration in the study for the first 2 treatments were coded into a numerical format suitable for data entry into the SPSS-X (footnote 1) computer program.
The palpation of various pulses on the radial arteries of the wrists and at other sites around the body served as the main form of diagnosis for this study. Pulses were palpated at 7/9 Continent Pulse sites around the body in the order listed:
Smith_A3 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 3.
a. in the depression midway between the calcaneal tendon and the medial malleolus of both feet;
b. at the highest point on the dorsum of the foot at the point where the dorsalis pedis artery can be palpated;
c. on the dorsum of the foot in the angle formed by the first and second metatarsals, just anterior to the articulation with the first and second cuniforms;
d. on the wrist crease at the proximal border of the pisiform bone in the depression at the radial side of the flexo carpi ulnaris tendon;
e. near the junction of the first and second metacarpals;
f. between the middle of the tragus and the mandibular joint where a depression is formed when the mouth is open; and.
g. on either sides of the temples.
At the conclusion of this process the author would then palpate the radial pulses concurrently on both wrists in accordance with the diagnostic concepts associated with TCM Pulse Diagnosis. This enabled the author to determine a profile of the patients' health in such a way that specific points could be selected for needling to thereby stimulate a healing response.
Various qualities within the pulses were subjectively interpreted by the author to reflect the patients' health within the framework of traditional Chinese AP. A maximum of 10 diagnostic criteria (DC1-10) were allowed for each patient as interpreted by the author from either the 9 Continent Pulses or the Wrist Pulses. A total of 150 different pulse qualities were recorded and listed alphabetically along with the frequency of occurrence. The author used 2-3 needles for most treatments. However some treatments required only one needle and others required 4-5. Hence the points were given the coding of PUF1-5 to allow for the possibility of 5 needles being used for one treatment.
Table 1 summarises the number of criteria pertaining to each of the major variables under consideration in the study:
Variable Number of Criteria.
Patient Symptoms 267.
Diagnostic Criteria (taken from Pulses) 150.
Points First Treatment 64.
Points Second Treatment 70.
Comments First Treatment 116.
Comments Second Treatment 105.
Table 1: Number of Criteria Pertaining to Each Variable.
Recoding
It was necessary to recode some of the major variables as the study progressed to facilitate an appropriate framework within the overall encoding structure for the computer program.
Patient symptoms (NPS) were divided into 6 categories with an appropriate numerical code as follows:
a.physiological: coded 1; b.comment not recorded: coded 2; c.musculoskeletal: coded 3; d.physiological/stress: coded 4; e.emotional/stress: coded 5; and f.musculoskeletal/stress: coded 6.
Patient comments after the first treatment (NPC) were re-classified into 4 categories as follows:
a.improvement: coded 1; b.no change in condition: coded 2; c.condition worse: coded 3; and d.comment not recorded: coded 4.
Individual pulses from which the diagnostic criteria were gained also were coded as follows:
a. in the depression midway between the calcaneal tendon and the medial maleollus of both feet: coded P1;
b. at the highest point on the dorsum of the foot at the point where the dorsalis pedis artery can be palpated: coded P2;
c. on the dorsum of the foot in the angle formed by the first and second metatarsals, just anterior to the articulation with the first and second cuniforms: coded P3;
d. on the wrist crease at the proximal border of the pisiform bone in the depression at the radial side of the flexo carpi ulnaris tendon: coded P4;
e. near the junction of the first and second metacarpals: coded P5;
f. between the middle of the tragus and the mandibular joint where a depression is formed when the mouth is open: coded P6;
g. on either sides of the temples: coded P7; and.
h. the pulse qualities taken from the 6 separate Wrist Pulses on each wrist were given a collective coding of P8.
The complexity of the Wrist Pulses necessitated the qualities being categorised together thus distinguishing them from those taken from sites around the body already described.
The final matrix incorporating the various codings to each variable was entered into the SPSS-X programme. The data pertaining to each patient was listed alongside the corresponding patient number and the data was analyzed as follows:
a. Stepwise Multiple Regression: P1-8 predicting DC1-10;
b. Stepwise Multiple Regression: DC1-10 predicting PUF1-5; and.
c. Crosstabulation of NCP against Symptoms (S1-6).
Results
The study has been predicated on the use of Pulse Diagnosis as a diagnostic tool. The author used the pulses to establish the most suitable AP points for needle insertion in order to treat a range of patient symptoms (footnote 2) (Smith, 1993).
Pulse Diagnosis is a complex art and, as such, requires a considerable degree of sensitivity in the finger tips. This is because many different qualities may be discerned from each individual pulse as well as the combination of pulses collectively. Resulting from this is a profile of the patient's health within the parameters of TCM. Pulse Diagnosis assists the practitioner to select and stimulate the most appropriate points from a range of suitable points in order to effect a corresponding improvement in that person's health.
Due to the complexity of interpreting pulse qualities, the pulses discerned from different parts of the patient's body (the 9 Continent Pulses) have been listed individually and separately from the Classical 6 pulses which are discerned from each wrist. The 9 Continent Pulses have been listed as P1 to P7 respectively while the Wrist Pulses have been listed collectively as P8. This means that P8 represents all of the diagnostic criteria deduced from the Pulse Diagnosis other than that information gained from the 9 Continent Pulses. The author considered that the complexity of attempting to quantify the myriad permutations and combinations of the Wrist Pulses (P8) alone into meaningful data was beyond the scope of the study.
The results from the SPSS-X analysis were categorised into 2 sections as follows:
a. Section 1.
1. Statement of Hypothesis 1.
2. Stepwise Multiple Regression: P1-8 Predicting DC1-10.
3. Stepwise Multiple Regression: DC1-10 Predicting PUF1-5.
b. Section 2.
1. Statement of Hypothesis 2.
2. Crosstabulation of NPC against Symptoms (S1-S6).
Section 1.
Hypothesis 1.
The diagnostic criteria taken from the pulses do not statistically significantly predict the AP points used in the treatment at p<.05 level of significance.
Stepwise Multiple Regression: P1-8 Predicting DC1-10.
Analysis of this data was to indicate that the pulses (P1-P8) predict the diagnostic criteria (DC1-10).
The information concerning the Stepwise Multiple Regression is summarised below in the form of a matrix showing those predictions which were statistically significant at .05 level of significance:
Smith_A4 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 4.
.
| DC | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10. |
| P1 | * | * | * | * | . | |||||
| P2 | . | |||||||||
| P3 | * | . | ||||||||
| P4 | * | * | * | . | ||||||
| P5 | . | |||||||||
| P6 | . | |||||||||
| P7 | * | * | . | |||||||
| P8 | * | * | * | * | * | * | * | * | *. |
The frequency of prediction by the pulses were as follows:
a.Pulse 8 (P8): 9 predictions; b.Pulse 1 (P1): 4 predictions; c.Pulse 4 (P4): 3 predictions; d.Pulse 7 (P7): 3 predictions; and e.Pulse 3 (P3): 1 predictions.
Conversely consideration of the Table 2 illustrates the frequency of the diagnostic criteria being predicted by the pulses as follows:
1.DC1: predicted by only one pulse (P8); 2.DC3: predicted by 3 pulses (P1, P3 and P8); 3.DC4: predicted by 2 pulses (P1 and P8); 4.DC5: predicted by 2 pulses (P1 and P4); 5.DC6: predicted by 3 pulses (P4, P7 and P8); 6.DC7: predicted by 4 pulses (P1, P4, P7 and P8); 7.DC8: predicted by only one pulse (P8); 8.DC9: predicted by 2 pulses (P7 and P8); 9.DC10: predicted by only one pulse (P8).
Analysis of Table 2 indicates that the following clustering occurred:
a.Pulses 4, 7 and 8 predicted DC6 and DC7; and b.Pulses l and 8 predicted DC3 and DC4.
Stepwise Multiple Regression: DC-DC10 predicting PUF1-5.
Analysis of this data was to indicate that the Diagnostic Criteria (DC1 to DC10) do not predict the points used for the first treatment. DC10 was excluded from the analysis due to insufficient data pertaining to DC10. The equations concerning PUF5 were deleted from the analysis due to insufficient data pertaining to PUF5.
Table 3 summarises the results of the Stepwise Multiple Regression:
.
| Entered Variable | Dependent Variable | Significance. |
| DC-DC9 | PUF | .7015. |
| DC6 | PUF2 | .0463. |
| DC-DC5; DC7-DC9 | PUF2 | .4310. |
| DC-DC9 | PUF3 | .9173. |
| DC-DC9 | PUF4 | .9172. |
Section 2.
Statement of Hypothesis 2.
The patients' comments after AP are independent of whether the patients' symptoms improved or not.
Crosstabulation of NPC against Symptoms (S1-6).
The results pertaining to the cross-tabulation of NPC against S2 have been deleted from the analysis due to S2 representing Comments Not Recorded. The cross-tabulation utilised 59% of the data pertaining to NPC due to the author only considering those patients who improved or did not improve. Table 4 summarises the relevant data:
| Variable | Significance | Contingency Coeff. |
| NPC-S1 | 0.9564 | 0.04324. |
| NPC-S3 | 1.0000 | 0.01611. |
| NPC-S4 | 0.7996 | 0.06833. |
| NPC-S5 | 0.7374 | 0.07777. |
Discussion.
The results indicate through the use of stepwise multiple regression prediction analysis that the Wrist Pulses (P8) was the most predictive of the diagnostic criteria. The pulses taken from the wrist (as distinct from any of the 9 Continent Pulses) involve palpating a complex and subtle arrangement of qualities, more so than for each individual 9 Continent Pulse or the collective of the 9 Continent Pulses. This applies particularly with Pulse Diagnosis taken in accordance with the Five Phase Theory due to the vast array of discernible qualities which may be palpated.
The iconography of the qualities of the pulses is interpreted by the practitioner and represents a profile of the patient's health in terms of TCM. It makes sematic sense that the bulk of the diagnostic criteria are predicted by the Wrist Pulses(P8) due to the greater iconography associated with taking those Wrist Pulses.
However the results indicated that several of the 9 Continent Pulses predicted various diagnostic criteria. In combination with the Wrist Pulses, the 9 Continent Pulses were useful in diagnosis. More research is needed to accurately determine the frequency of prediction of the diagnostic criteria by the 9 Continent Pulses and the Wrist Pulses.
The stepwise multiple regression indicated that the diagnostic criteria did not predict the points used for the treatment. The only exception to this was DC6 (6th diagnostic criteria) predicting the second point used in the treatment (PUF2). The author considered the prediction of PUF2 by DC6 to be an aberration.
Pulse Diagnosis is considered by the author to pertain to that individual patient at the specific time of diagnosis. Literally any AP point may be used by the practitioner if it is in accordance with the complex matrix of diagnosis as indicated by the pulses. The individual point functions are not the only criteria to be considered by the practitioner in the selection process (Smith, 1993).
The intricate relationships of one point to all of the others chosen means that the prediction and ultimate selection of points is an extremely subtle and subjective task. While some statistical evidence suggests that the pulses predict the diagnostic criteria, the relationship of the diagnostic criteria to the final selection of AP points is complicated and diverse when using Pulse Diagnosis as the major form of diagnosis from which points are selected.
While the author acknowledges that the determination of the diagnostic criteria precedes the selection of the most suitable AP points, the complexity of interpreting the subtlety and subjectivity of such a process suggests that a different research model other than Ex Post Facto may need to be utilised to obtain more meaningful data.
More research is needed to determine the statistical relationship of the diagnostic criteria with the points selected. Crosstabulating patient symptoms against patient comments indicated that the comments at the end of the treatments were independent of whether the patients symptoms improved or not. Although the study did provide some evidence that the process of traditional AP begins with the patient elucidating various symptoms it is the patients comments that conclude the process.
The patients' symptoms were not related to the process of traditional AP when Pulse Diagnosis was used as the main form of diagnosis. This makes sense, as the author's treatments were based on the diagnostic criteria as described by the pulses rather than by the patient's symptoms.
While it is clear that further research is required into Pulse Diagnosis as a diagnostic technique, the study indicates a possibility that Pulse Diagnosis HAS a scientific basis. This in itself may indicate that educational institutions which teach AP may find it useful to include in their curricula the theory and practice of Pulse Diagnosis if not already doing so.
Conclusion
The Wrist Pulses were statistically more predictive of diagnosis than the 9 Continent Pulses. However, when combined with the Wrist Pulses, the 9 Continent Pulses had some use in diagnosis.
Smith_A5 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 5.
The author could not confirm that the diagnostic criteria predict the points used for the treatment. A more sophisticated computer programme may be required over and above the SPSS-X to examine his relationship further.
The patient's comments after the treatment were statistically independent of whether the patients improved or not.
More research is needed in this field to determine the efficacy of the Wrist Pulses as a diagnostic tool. Also, research is needed to clarify the frequency of prediction of the diagnostic criteria by the 9 Continent Pulses and the specific clustering which occurred of the diagnostic criteria in relation to the pulses.
Statistically, there was some evidence to suggest a scientific framework underpinning Pulse Diagnosis. Pulses taken in accordance with Five Phase Theory rather than the classic 28 pulse qualities, may be a more appropriate method of taking pulses as a means of TCM diagnosis. The evidence suggests that Five Phase Pulse Diagnosis is a valid form of Pulse Diagnosis.
The qualitative approach to AP uses philosophical concepts from millenia of clinical use. However, the diagnostic art of Pulse Diagnosis is centred on a coherent methodology which may have a scientific basis. While the Ex Post Facto method of research has proved useful for the study, it did not seem fully adequate to explain the qualitative paradigm to which Pulse Diagnosis and AP belong.
Educational institutions which teach AP may find it useful to include in their curricula the theory and practice of Pulse Diagnosis if not already doing so. Integrating Pulse Diagnosis into the Med and Vet AP courses may help to juxtapose the many advantages of AP with the advantages of Mod Med. It may also help the graduates of AP courses to better understand the mechanisms underpinning the AP effect within the qualitative paradigm of traditional AP.
Understanding that AP has a coherent methodology while still being inherently different from WM may assist people in developing the confidence to learn more about their health within the paradigm of TCM. The AP and Med professions should work together to disseminate information about the benefits of AP that may appeal to the general public. Combining the many benefits of WM with the drug-free and low cost advantages of AP may improve the quality of choice and accessibility of well-being in the provision of primary health care within Australia.
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Footnotes
1 Statistical Package for Social Scientists.
2 Specific details are contained in the author's M Educ Thesis (1993), Univ of Canberra: Pulse Diagnosis in Traditional AP.