In fact, the position of pulse diagnosis in the four diagnoses of Chinese medicine currently seems to have two extremes in our Chinese medicine community. At one extreme, pulse diagnosis is too important. I just said that the cough is cured, and 70% of coughs can be prescribed if they hear a sound;There are also many doctors who say that I can prescribe 100% of the diseases or 80% or 60% of the diseases by taking the pulse in clinical practice, which expands the role of pulse diagnosis too much. There are also some doctors, I have heard that some doctors do not have time to take the pulse, so they directly say that the pulse diagnosis is useless in clinical practice, but it is not necessary.
Pulse diagnosis occupies an important position in the four diagnoses of traditional Chinese medicine, but it is not as indispensable as imagined. Among the four diagnoses, pulse diagnosis is not the most important part, but one of the four diagnoses, and it is placed at the end of the four diagnoses. This does not mean that pulse diagnosis is the least important, but rather indicates that it is the last step of the four. In any case, pulse diagnosis is only a means of obtaining patient information.
Although pulse diagnosis is only one of the four diagnoses, it is regarded as one of the two most distinctive routines of Chinese medicine. When a patient seeks TCM**, the doctor must perform two major routine examinations, namely looking at the tongue and taking the pulse. If a doctor prescribes without performing these two tests, patients may be confused or even question the doctor's ability to diagnose. This shows that many patients have high expectations for TCM pulse diagnosis.
From the perspective of traditional Chinese medicine, pulse diagnosis does have a certain value, but it cannot be used to judge diseases based on pulse diagnosis alone. As medical students, we have all studied "Diagnostics of Traditional Chinese Medicine", emphasizing the importance of the four diagnoses. Therefore, I think that pulse diagnosis plays an important role in the four diagnoses of traditional Chinese medicine, but it cannot be judged based on pulse diagnosis alone. Any over-exaggeration or denial of pulse diagnosis is not an objective evaluation.
Regarding the current status of pulse diagnosis, there are indeed some problems. In my actual observations, I found that there are two kinds of people in the Chinese medicine community. One is to exaggerate the role of pulse diagnosis, but in the clinical practice I have observed, I have not seen them actually apply pulse diagnosis to practice. On the contrary, many clinicians oversimplify the application of pulse diagnosis, and some even treat pulse diagnosis as a non-existent thing.
It should be deeply appreciated for students who are interning in hospitals or studying under teachers. Many physicians focus clinically on only three pulses: strings, slow, and slippery. Some doctors even treat pulse testing as a mere formality, because if it is not performed, the patient may not be convinced.
In my opinion, there are four main reasons for the unsatisfactory application of pulse diagnosis. First of all, the question of methodology is a key. Due to the unclear understanding of the system of pulse change characteristics, it is difficult for us to truly grasp the pulse system. Secondly, the issue of application is also an important factor. Many doctors do not have standardized pulse cutting techniques, which makes it difficult to understand under the fingers, that is, the heart is not clear and the fingers cannot be felt. In addition, the rules of syndrome are very complex, and the relationship between pulse and clinical disease is not one-to-one, so it is difficult to grasp the correspondence. Finally, the lack of understanding of the practical value of pulse diagnosis is also a problem. Many TCM practitioners believe that pulse diagnosis has no practical value in clinical practice and is therefore rarely used in practice.
In my clinical practice, including when interacting with some of my college classmates who work in county-level hospitals, they all say that it is difficult to master pulse diagnosis skills. Although they were familiar with the 28 pulses in college, they found that many pulses did not match the descriptions in the book when they applied them in clinical practice, so they gradually lost confidence and finally gave up using pulse diagnosis.