Let's try to comprehend how the Tian system actually works. First, I think it will help us think about it less than a system of pulse diagnosis, but more a system of ‘pulse prescribing’. The important difference here is that the pulse leads to a prescription, and this is in line with the classical approach of the Shang Han Lun where ‘the treatment is the diagnosis’. I would like to share my first time as a PCOM intern seeing this play out. I struggled as an intern until I found this system. After taking a pulse and finding guizhi, longgu, and muli findings, I knew exactly what formula to write! After leaving her on the table I went into the hallway and jumped up and down waving my arms in the air in triumph, much to the amusement of my observer. Let’s get back to pulses and I promise there will be no more acrobatics mentioned.
Yelp. (n.d.). [Image from Yelp]. Yelp. Available here.
A pulse diagnosis system that is accurate, fast and efficient is not a standalone entity. It exists in the context of a system in which the understanding of physiology, pathology, diagnosis, and formula construction are fully aligned. This might sound obvious, but in practice this is rarely the case in Chinese medicine. And when this is the case it becomes less about ‘pulse diagnosis’ and more a case of ‘pulse prescribing’, as the Tian system adheres to the maxim, common in many schools of classical thought, that ‘the treatment is the diagnosis’.
The Tian lineage is based on the Shang Han Za Bing Lun and so uses the 5 elements and 6 conformation models as its theoretical basis. In the interests of simplicity and clarity, we will primarily explain the Tian pulse system in the context of the 6 conformation model. The 6 conformation model (Taiyang, Yangming, Shaoyang, Taiyin, Shaoyin and Jueyin) essentially describes the waxing and waning of yin and yang in physiology, the damage to yang, and the body's functions failing as a result of this in pathology.
If a pulse is not deep, then it is a yang conformation. Additionally, if on top of that it is floating, then this is a further yang quality and so it is yang within yang. This indicates a pathology of the greatest yang conformation, Tai yang. Line one of the Shang Han Lun states ‘In Tai Yang disease the pulse is floating’. If the pulse is not deep, it is again a yang conformation, but if it is wiry this is then a yin quality, and so it is yin within yang, and shows pathology of the least yang, and therefore most yin, of the yang conformations, the shao yang or lesser yang conformation, as stated in Shang Han Lun line 265 ‘In cold damage when there is a thin wiry pulse… this belongs to shao yang’. This is the basic structure of this pulse system. Now let’s do something cool- again, I promise no acrobatics. Let’s look at how this will translate into the actual prescription of formulas directly from the pulse.
The herb method, Guizhi and Taiyang as example
Zhang Zhongjing identified the key herbs which embodied specific body functions, known as the ‘herb method’. He then built a modular formula system around combinations of these herbs. For example, the Taiyang conformation is concerned with the circulation of warm blood supplied by the heart to the small intestine to warm the bladder system and promote water metabolism and the proliferation of this warm blood to the periphery to maintain surface body temperature. Guizhi embodies this function. As mentioned in the Shennong Bencao Jing, Guizhi is warm and pungent, and in the Tangye Jing (Decoction Classic), the text upon which Zhang Zhongjing based his formula system, it is categorized as the wood herb of the wood class . This means that it is a pungent flavor and so tonifies the wood element. A stronger wood element is better able to generate the fire element, thereby strengthening the function of the heart, the body’s source of yang, to send more warm blood down to the small intestine, which in turn warms the bladder, thereby providing more warm blood for the Taiyang conformation.
As the greatest yang conformation, and one that is rich in blood, any pathology of Taiyang has at its root damage to yang, or cooling off of the blood of the body, and so requires the use of Guizhi to restore the damaged physiology of Taiyang.
Thus, when treating Taiyang one must use Guizhi, and when using Guizhi one is treating Taiyang, and if one is not using Guizhi, then one is not treating Taiyang.
Herb method Guizhi and pulse relationship
When damage to the peripheral circulation of yang (via the blood), i.e. the Taiyang conformation, occurs, it will produce a very specific pulse, and as Guizhi is the primary herb to restore this damage to physiology, rather than calling this a ‘Taiyang pulse’ the Tian system would term it a ‘Guizhi pulse’, in most cases a superficial pulse on the left cun. Let’s take a second to pause and think about this. Now you actually know a pulse that corresponds to an herbal strategy. For me, this was really groundbreaking. Let me ask my reader a question: what is wrong with the following sentence: hey meet me at Starbucks. The problem dear reader is which Starbucks. If you are reading this in Seattle or NYC or any major city, the possibilities are in the thousands. The pulse is floating, yes. But where is it floating? This is so very important and helps you decide on what formula to write. You have eliminated the need for the additional steps of diagnosis, treatment principle, treatment strategy, etc. You arrive at the end point of what needs to be done.
Maybe you’ve realized that this is a vast topic and we are only able to scratch the surface in this Kamwo article. We could delve into multiple variations and possibilities that exist within the pathologies of the human body, the formulas of Shang Han Za Bing Lun, of which there are 314, and the concurrent pulses of the Tian lineage method. It would be impossible to do so in fact, and largely pointless, as although both the Tian lineage pulse method and the Shang Han Za Bing Lun as rooted in a solid theoretical foundation, they are ultimately practical methods, which must be learned in a clinic with a teacher shepherding the student down the path. This is why it is so important to find a teacher to teach you the pulse. I was lucky to find my teacher, Dr. Arnaud Versluys. You can trace his pulse taking lineage directly back to Dr Tian. I am proud to call myself part of the Tian family pulse taking tradition. I dare say finding the right teacher is akin to finding the right spouse. I hope you have found this interesting and even exciting. I can tell you that this system is very much still alive and well. It lives on in over 400 people worldwide. We will be offering this training starting in September and you can learn more at the link I have at the bottom. If you have any questions for me, don’t hesitate to email me about anything. If you want to talk about a tough case, consider me a resource. You can reach me at ccampbell@newyork.iceam.org
Find out more and register for our first hybrid series at http://www.iceam.org/venue/new-york/
Yelp. (n.d.). [Image from Yelp of Campbell Acupuncture]. Yelp. Available here.
About Collin Campbell
Collin received his Masters of Acupuncture and Oriental Medicine from the Pacific College of Oriental Medicine (PCOM) Chicago in 2011. He graduated PCOM with an extra 2,700 hours of clinical experience under the tutelage of two senior professors: Frank Scott, L.Ac, Academic Dean at Pacific College, and Marie France Collin, L.Ac, Department Chair for Acupuncture at PCOM. He then pursued post-graduate studies in herbal medicine exclusively, earning 2 extra qualifications in classical Chinese herbology. He is a Diplomat of The Institute of Classics in East Asian Medicine (ICEAM) and among a select few that have reached fellowship status at ICEAM. Dedicated to continually improving his clinical skills, he is the only student to have amassed over 1,000 visits with his teacher, mentor and ICEAM director, Dr. Arnaud Versluys, an esteemed Western scholar who received his full medical training in China. Collin lectures for ICEAM in Chicago, Boston and internationally.