Pulse-Taking Is Far Less Important Than a Patient History Taken Patiently
I am not good at pulse diagnosis. Beyond the classic floating/sinking/slow/rapid, I am unsure whether my readings are right, and even my interpretation of those is shaky. This may shock many, who cannot believe someone like me has such weak pulse skills.
Professor Jiang Chunhua once planned a pulse-diagnosis study: he gathered famous Shanghai TCM doctors, had them feel the same patients' pulses, record findings, and analyze. The agreement rate was under 15%—shocking. He abandoned the project and studied tongue diagnosis instead, which is more objective; pulse is too subjective, he felt.
He discussed this in his book Zhongyi yu Kexue (Chinese Medicine and Science); interested readers may find it. Jiang came from a TCM family, studied under his father, and became one of Shanghai's most famous TCM professors with outstanding results. Commissioned by the Ministry of Health, he led Shanghai TCM experts in specialized research and identified problems needing reform; he was criticized by many colleagues for it. It could not be helped—say anything about TCM and you get criticized.
After the pandemic I had to abandon face-to-face pulse diagnosis and focus on history and tongue, which work over video. This saves patients money and reduces cross-infection, and my results improved. Four-diagnosis integration should be better than history-plus-tongue alone—why the improvement? Because without the pulse I was misled less.
Taking the pulse, I was easily led astray by ancient, loose theories and kept straining to decide what pulse and disease a patient 'should' have. Dropping the pulse, I focused patiently on the history, gathering every symptom clearly, then per the formula-pattern school searched my knowledge base for the matching formula, checking references when unsure. Results beat in-person visits.
A rhinitis patient referred by an acquaintance told me today that, over the screen and without pulse, I cured her years-long rhinitis—astonishing. She had consulted many doctors in vain and nearly lost hope. I thought: had I taken her pulse and been uncertain, I might have detoured and done worse.
After history I often check references to sharpen judgment. I am grateful to my patients—they are kind. I often tell them, 'I am not sure about this; I will record it and check references, then reply.' They do not despise my knowledge; they wait patiently. In-person I could not do this— I had to prescribe on the spot, sometimes underprepared, and results suffered.
I once saw a foreign film (I forget the name) about a Black doctor who loved research, poring over literature for long hours for a single patient, and who creatively performed separation surgery on conjoined twins; the film praised his diligence. Watching, I thought: such a doctor in China would be drowned in patient complaints, deemed inexperienced and needing to cram at the last minute.
My worry was misplaced: many Chinese patients like a doctor who checks references, seeing it as diligence and responsibility rather than perfunctory excuses. Others prefer confident doctors who never open a book.
I have always considered my skill ordinary, yet I occasionally cure patients other doctors could not—though I also do poorly for many, who do better elsewhere, so there is nothing to boast of. I attribute my occasional results to very careful history. I give at least ten minutes, often half an hour or more, gathering all signs, analyzing the reported symptoms, and concluding which formula to use. Such history can err, but far less often.
These years I lean toward the formula-pattern school and endorse Professor Hu Xishu's saying that 'formula-pattern differentiation is the highest level of pattern differentiation.' I focus on memorizing formula and herb indications rather than circling yin-yang and five phases. Clinically I value symptoms as the main basis for prescribing, and results satisfy patients and me.
Some TCM peers say we have not even entered TCM's gate, yet their own results are no better. Professor Hu, in his lifetime, mercilessly criticized TCM's stale theories, yet the difficult and severe cases at the Beijing University of Chinese Medicine hospital often needed his decisive diagnosis. This is because TCM basic theory is too detached from clinical reality; the better one knows the theory, the worse the results can be. A doctor at Beijing Chaoyang Hospital once told me that a pharmacy-apprentice-turned-TCM doctor there outperformed a Beijing TCM University professor. In lecturing, of course, the professor was more brilliant.
I rarely take pulses when treating myself and family, with decent results. In my view, to learn and use TCM well, we should be wary of overly idealist sayings like 'medicine depends on the doctor's intuition,' avoid over-subjective guesswork, and master more objective diagnostic methods. That reduces error and raises success. I intend to go further down this road.