| BackgroundPulse examination is belonged to the four ways of diagnosis of TCM, meaning a physician uses his fingers to feel and press a patient’s pulse and according to the pulse condition he gets to know the disease and differentiates the syndrome. Pulse-taking is depended on subjective sensation of the physician’s fingers. So the physicians on past dynasties has different viewpoints. The textbooks of diagnostics of TCM introduce the28pulses, including the feature of pulse condition and clinical significance. Are the textbooks the same as the reality of clinical? Are they fully inheritance and expressed the understanding of the ancients’ viewpoints? Based on these questions, the research will study the floating and deep pulse which are belonged to28pulses by literature study and expert interview.Objective1.To know the current situation of the floating and the deep pulse, this study sorted out and analyzed the textbooks of "Diagnostics of TCM", internal medicine of TCM, surgical department of TCM and gynaecology of TCM.2.Invested the feature of pulse condition and clinical significance of the floating and the deep pulse in clinical application by Expert interview.3. To tease out the process of the development by combing the documents from the contemporary to the ancient.4.To provide the basis for research on the standardization of the pulse condition and the writing of the textbook which enhancing the practical value of the pulse examination.Methods1. This study searched and sorted out the description and the application of the floating and the deep pulse systematically in the contemporary "Diagnostics of the Traditional Chinese Medicine" and a great deal of teaching materials on internal medicine, surgical department, gynaecology and etc. in Traditional Chinese Medicine. Then the study analyzed the current recognition of the floating and the deep pulse in contemporary.2. On the basis of the divergence in the recognition of the moderate pulse nowadays, this study drew up an outline for interviews, applying open-ended questions, through interviews on clinical experts of TCM with various specialties, looked into the recognition and application on the features of pulse conditions of the floating and the deep pulse among the contemporary experts, summed up amd analyzed the discrepancies between the actual clinical application and teaching materials/monographs on the moderate pulse.3. Collected the representative literatures of TCM, then analyzed and summarize the tracks of the feature of pulse condition and clinical significance of the floating and the deep pulse among physicians throughout various periods.Results1. The understanding of the feature of pulse condition and clinical significance of the floating and the deep pulse by college textbooks.There is consistent understanding of the Diagnostics of TCM textbook relatively. The floating and the deep pulse reflect the pulse location, the former superficial and the latter deep. All the description of textbooks before "Sixth version" are about the clinical significance on diseases or syndromes. The floating pulse suggests exterior or deficiency syndrome. The deep pulse suggests interior syndrome. The textbooks after the "Sixth version" have physiological significance. The floating pulse may seen in thin body and summer and autumn. The deep pulse may seen in fat body and winter.There are different views between the clinical and diagnostics textbooks. the floating and the deep pulse always appear together with other pulses. the floating pulse also suggests wind syndrome, damp-heat syndrome, stomachache caused by stagnation of qi and palpitation caused by noxious. The deep pulse suggests interior syndrome. And it depends on other pulses to suggest specific one.2. The survey about the feature of pulse condition and clinical significance of the floating and the deep pulse based on expert interviewThere is different understanding among experts. The most experts agree that the floating and the deep pulse describe the opposite pulse location. But someone suggest that the power of the floating pulse is not sufficient, or have tendency of upward, outward. Experts stressed the importance of from the normal health state to find out abnormal changes applied on pulse diagnostics. The floating pulse suggests exterior or deficiency syndrome and physiology to thin body. The deep pulse suggests interior syndrome and physiology to fat body. It is not obvious about the human body pulse condition corresponding to the four seasons in clinical. Experts stressed the importance of comprehensive analysis by the four examination methods rather than the diagnosis from pulses only.3. The study of teasing out the process of the development of the feature of pulse condition and clinical significance of the floating and the deep pulse.Not all of the doctors had the same opinion on the feature of pulse condition and clinical significance of the floating and the deep pulse on different time, summarized as follows:During the dynasties of Qin and Han:"Nan Jing" described the feature of the floating pulse for the first time. In "Nei Jing", the floating pulse was Yang pulse, ac-cordingly with the autumn and the lung; the deep pulse was Yin pulse, accordingly with the winter and the kidney,"float" and "deep" were used as adjectives to describe the dynamic change of normal person, which related to the seasons and the six factors in nature. The floating pulse suggested new, relieving or outside disease, heat syn-drome, Qi activity outside, prosperous of Taiyang and Yangming meridians or Fengshui. The deep pulse suggested aeipathia, organs or inside disease, cold synd-rome, Qi down fell, prosperous of Shaoyin meridians or Shishui."Nan Jing" described the normal feature of the pulses of five internal organs, which related the the floating pulse to the heart and lung and cun pulse, the deep pulse to the liver and kidney and chi pulse. the floating pulse suggested these diseases and disease location be superficial.Time to "Treatise on febrile disease" and "Synopsis of the Golden Chamber", Zhang zhongjing thought the thin person should be floating pulse and the fat person should be the deep pulse in normal. He discussed that\the floating pulse suggesting exterior syndrome, carbuncle, the recovery of Yangqi or lighter illness; the deep pulse suggesting inside disease, wetness syndrome or Promordial Qi strong."Treatise on febrile disease" payed special attention to a dynamic change of human body pulse location. The floating and the deep pulse are not only important evidence for diagnosis and differential diagnosis, but also judged the trend of disease development and prognosisIn the periods of three kingdoms, two Jins and Northern Southern dynasties: Sphygmology diagnostics became a specialty, and the "Mai Jing" was a product of representativeness. It was the first time that the features of pulse conditions on the floating pulse and the deep pulse were described in the book. it inherited and developed the former views, then putted out new ideas. The floating pulse suggested superficial syndrome, including exterior syndrome and the specific location of the disease. The deep pulse suggested frightened."Mai Jing" also discussed how to predict pregnant women boy or girl through pulse.In Tang, Song and Ming dynasty, most doctors were agreed with the opinions of "Mai Jing". Someone thought the floating pulse and the deep pulse had other features besides location. Zhang jingyue began to rethink and put forward that exterior syndrome was not necessarily the floating pulse and the deep pulse was visible.In the Qing dynasty and republican period, Zhanglu pointed out the difference between floating and rootless pulse. On the aspect of clinical indications, someone thought the deep pulse suggested cold syndrome, heat syndrome, deficiency syndrome, or substation syndrome when it appeared with other pulse. There was difference among normal person, which was not related to disease.In modern times, the floating pulse and the deep pulse is defined strictly they do not have other elements except the pulse location, the former superficial and the latter deep.. some doctor explain the clinical significance from its formation mechanism. On other hand, someone try to discuss the clinical significance in the way of combining western medicine disease and syndrome.Conclusions1. The floating and the deep pulse are different from pulse floating and deep. The floating and the deep pulse have no other element except the pulse location. Floating and deep are adjective words and pulse floating and deep are with other pulse elements unnormal.2. There are both physiological and pathological clinical significance with the floating and the deep pulse. The pulse location is related to the bodily form, character, sex, age, mental state, dietary habit, living environment etc. on physiological conditions. Human pulse position can be changed with the transformation of natural climate and the seasons. The floating pulse suggests exterior or deficiency or wind syndrome, and the deep pulse suggests interior syndrome or dampness syndrome on pathologic condition.3. The ancients payed special attention to a dynamic change of human body pulse location. The floating and the deep pulse are not only important evidence for diagnosis and differential diagnosis, but also judged the trend of disease development and prognosis, which has important value but the textbooks are not mentioned.4.The floating pulse indicates new, fu,upside, skin, fur, yang meridians disease, and the deep pulse indicates old, zang,underside, yin meridians disease. The clinical significance maybe not conform to the clinical pracrice,because they are deduced from the charater of Yin and Yang.5.We suggest to use the form of "often seen in......" to describe the clinical significance in the text book of diagnostic of TCM. 6.Knowing commonnes of the disease for change should also include anther meaning, which is measuring the performance of disease to the people’s health status.All of the conclusions above are based on literature, which need clinical studyto verfy.
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