Chinese Pulse Diagnosis- 

In Traditional Chinese Medicine (TCM) , before acupuncture, herbs and massage are prescribed, a diagnosis is made from evaluation of the pulse and examination of the tongue.  Pulse diagnosis is not at all similar to evaluation of pulse in modern medicine, instead is a perception of energies flowing through the body and any obstruction to such flow. From the work of Stephen Barrett, MD it can be seen the diagnosis and therapy prescribed varies wildly from one TCM practitioner to the next, even when they have years of training. 

"Researchers who examined 16 TCM acupuncture texts or treatment articles to determine the consistency of diagnosis and recommended treatment for chronic low-back pain. Although 24 diagnostic patterns were described by one or more texts, only 4 patterns were described by at least half of them. Most texts (12/16) described only 3 or 4 patterns. The patterns could be categorized into 3 broad types:

1. Cold, damp, wind, heat channel obstruction patterns

2. Kidney vacuity patterns (sometimes differentiated into yang and yin patterns)

3. blood (or blood and qi) stasis patterns.

Several acupuncture points were recommended by most texts regardless of the diagnosis, whereas other acupoints were recommended for specific diagnostic patterns. There was, however, substantial variation between texts in recommended acupoints, with fewer than 20% of all acupoints recommended by half or more of the texts [1].

In a study published in 2001, a 40-year-old woman with chronic back pain who visited seven acupuncturists during a 2-week period was diagnosed with "Qi stagnation" by 6 of them, "blood stagnation" by 5 , "kidney Qi deficiency" by 2, "yin deficiency" by 1, and "liver Qi deficiency" by 1. The proposed treatments varied even more. Among the six who recorded their recommendations, the practitioners planned to use between 7 and 26 needles inserted into 4 to 16 specific "acupuncture points" in the back, leg, hand, and foot. Of 28 acupuncture points selected, only 4 (14%) were prescribed by two or more acupuncturists. [2]. The study appears to have been designed to make the results as consistent as possible. All of the acupuncturists had been trained at a school of traditional Chinese medicine (TCM). Six other volunteers were excluded because they "used highly atypical practices," and three were excluded because they had been in practice for less than three years. The study's authors stated that the diagnostic findings showed "considerable consistency" because nearly all of the practitioners found Qi or blood stagnation. However, the most likely explanation was that these are diagnosed in nearly everyone.

In another study, six TCM acupuncturists evaluated the same six patients on the same day. Twenty diagnoses and 65 acupoints were used at least once. The diagnosis of "Qi/Blood Stagnation with Kidney Deficiency" and the acupoint UB23 were used for every patient by most acupuncturists. However, consistency across acupuncturists regarding diagnostic details and other acupoints was poor. No diagnoses, and only one acupoint, were used preferentially for a subgroup of patients. Some diagnoses and treatment recommendations were dependent more on the practitioner than on the patient. Fine-grained diagnoses and most acupoints were unrelated to either patient or practitioner. The researchers concluded that TCM diagnoses and treatment recommendations for specific patients with chronic low back pain vary widely from one practitioner to another [3].

Another study examined TCM diagnoses and treatments for patients with chronic low-back pain using two separate sets of treatment records. Information from more than 150 initial visits was available for analysis. A diagnosis of "Qi and Blood Stagnation" or "Qi Stagnation" was made for 85% of patients. A diagnosis of kidney deficiency (or one of its three subtypes) was made for 33%-51% of patients. Other specific diagnoses were made for less than 20% of the patients. An average of 12-13 needles was used in each treatment. Although more than 85 different acupoints were used in each data set, only 5 or 6 acupoints were used in more than 20 of the treatments in each data set. Only two of those acupoints (UB23, UB40) were the same for both sources of data. More than half of the patients received adjunctive treatments, including heat (36%-67%), and cupping (16%-21%). There was substantial variability in treatments among providers [4].

In a larger study published in 2004, three TCM practitioners examined the same 39 rheumatoid arthritis (RA) patients separately at the University of Maryland General Clinical Research Center. Each patient filled out a questionnaire and underwent a physical examination that included tongue and pulse diagnosis. Then each practitioner provided both a TCM diagnosis and a herbal prescription. Agreement on TCM diagnoses among the 3 pairs of TCM practitioners ranged from 25.6% to 33.3%. The degree to which the herbal prescriptions agreed with textbook recommended practice of each TCM diagnosis ranged from 87.2% to 100%. The study's authors concluded:

The total agreement on TCM diagnosis on RA patients among 3 TCM practitioners was low. When less stringent, but theoretically justifiable, criteria were employed, greater consensus was obtained. . . . The correspondence between the TCM diagnosis and the herbal formula prescribed for that diagnosis was high, although there was little agreement among the 3 practitioners with respect to the herbal formulas prescribed for individual patients [5].

The University of Maryland researchers then repeated the above study using 40 RA patients and three practitioners who had had at least five years of experience. The results were nearly identical to the previous findings [6]."  Therefore pulse diagnosis not only results in significant disagreement, but the applied use of therapies also varies wildly, bringing into question both the diagnostic consistency of pulse diagnosis and the therapies used. 

Ref. 1. Alternative and Complementary Medicine 5:4150425, 1999.  2. Southern Medical Journal 94:486-492, 2001  3. Complementary Therapies in Medicine 9:154-166, 2001.  4. Alternative and Complementary Medicine 7:641-650, 2001.  5. Alternative Therapies in Health and Medicine 10:58-63, 2004  6. Alternative Therapies in Health and Medicine 11:415-421, 2005.