Contextualising pulse within contemporary clinical practice

Pulse diagnosis knowledge and its teaching is sometimes written about in nostalgic terms when referring to the traditional methods of learning Chinese medicine (CM) within the master — apprentice system. In this system a student would indenture themselves to a practitioner in exchange for learning CM. This has been termed a ‘craft’ method of learning, not dissimilar to the European craft system or apprenticeship model (Higgs & Edwards 1999, Swart et al 2005):

Traditional apprentice systems also have a tendency to focus on traditions to the exclusion of new innovations. Knowledge associated with the rapid and ongoing development in both CM and biomedical fields of health may additionally be excluded from such systems of training. Thus, as a sole model of education, it is probably unsuitable for providing the basic foundational training required of CM practitioners in the modern context. This is because the contemporary or modern practitioner requires knowledge attained from the biomedical system, in addition to the CM system, in order to practice within an increasingly regulated environment. Such knowledge and regulatory requirements for individuals entering the CM profession today render the traditional apprenticeship model of training as either an adjunct to structured degree courses, or suitable for neophyte practitioners as a postgraduate study stream.

Within the modern context of CM education, most practitioners receive their foundational training from attending structured tertiary courses rather than the craft or apprenticeship system. There are a number of reasons for this. Primarily, there are relatively large numbers of individuals entering the profession with too few established practitioners willing to participate in the training of neophyte practitioners. For example, the British Medical Association noted a 36% increase in acupuncture practitioners and a 51% increase in allied health practitioners using acupuncture from 1998 to the year 2000 (BMA 2000). Such an increase in practitioner numbers within a short time frame could never have been catered for by established CM practitioners using traditional apprenticeship training methods (assuming that the ‘new’ practitioners were all appropriately trained).

Courses have been created to meet the demand for CM education in many countries, with sound programs structured to produce competent CM health professionals. In some educational sectors, this has meant developing courses and course content to meet specific criteria developed by regulatory or accreditation bodies. For example, the Australian state of Victoria has a Chinese Medicine Registration Board that requires benchmarks in knowledge and associated skills to be met by graduates from university and other tertiary programs in acupuncture and CM in that state in order to practise in that state. The process for developing such courses is not solely driven by educators but is often in response to CM industry directives. For example, a joint working party representing educators and industry bodies developed guidelines for education of primary CM practitioners in Australia, making reference to similar documentation prepared by the World Health Organization (NASC 2001, WHO 1999). In the US the Acupuncture Examining Committee and the National Commission for the Certification of Acupuncturists (NCCA) set industry entry exam requirements for those wishing to be licensed to practice (BMA 2000). Other countries have set minimum competency benchmarks for the safe and knowledgeable practice of acupuncture, such as New Zealand’s National Diploma of Acupuncture. In addition to educational requirements, many countries are moving to a regulatory model for the practice of CM and acupuncture on concerns of potential risks of harm to patient health and safety.

Accordingly, this book addresses knowledge and skill guidelines for developing a solid foundation in pulse diagnosis. It is as relevant for those from a range of training methods as it is for those from academia. It is a flexible modulated guide to pulse diagnosis and is relevant to regulatory requirements for CM education in pulse diagnosis. It is also an appropriate basis for further learning in other systems of pulse diagnosis such as the family lineage teachings or for further study of other complex systems of pulse diagnosis such as described in the Mai Jing(Wang, Yang (trans) 1997).

A misconception about the use of pulse diagnosis is that it was never intended to be used as the sole method of diagnosis. Ideally, the pulse should be appropriately used in conjunction with other diagnostic practices and this was detailed in several classic literature sources. Yet other classical texts such as the Nan Jing