(or Reflections on The Diagnostic Touch)
The times are changing and perhaps more exponentially, or more rapidly than ever before. Tech is venerated as some new god that will redeem us all, as we get swept up in a tsunami of information unprecedented in human history. For folks who are digital migrants, we have either taken to it like a fish to water, or we have started to feel like we are really drowning. In my own work, there’s now an unspoken burgeoning pressure to somehow be ahead of this game as most people now are wont to self-diagnose via advice from Dr Google. Some people subscribe to every internet health gurus eNews, and as a result not only end up taking every supplement and ‘superherb’ that’s on trend, or worse – start prescribing these wonder drugs indiscriminately as some sort of panacea to everyone they meet. At the other end of this spectrum, we also have clients who are on about twelve different pharmaceuticals and so we now have to wade through which drug is for the original ailment, which are for the side-effects, possible drug-herb interactions, contraindications, and half-lives. And then we have to figure out if we can actually be of help at all, and if they have a doctor who is willing to work with us to begin to wean the patient of this chemical cocktail. The mindset that births both of these extremes is the same. In this Age of Instant Gratification & Technological Wonderment, it is the reductionist mindset of the quick fix. And as a result, we are losing our traditional knowledge and understanding of the unique essence and specific virtues of the plants, and we are losing our skills of diagnostics. And why not? We have the machines that go ping to do that for us now. (And we have standardised plant extracts – but that’s another story). We are losing touch.
But machines, or even standard lab tests, can’t detect nuance. They can’t depth diagnose through empathy or perceive the dynamics of the life experience that courses through a patient’s veins. They can only take snap shots of that given moment, without regard to extenuating circumstances. The conventional assessment of blood pressure is a prime example.
Before medicine became technological and profit-driven by the pharmaceutical companies, the physicians/healers themselves, if they were any good, had to also be skilled diagnosticians. Trained on the job, their own bodies were highly aware, acutely sensitive diagnostic instruments. The full use of all of their senses was employed to make an accurate assessment of the dynamic being that sat or lay before them. Mindful observation of mannerisms, pallor of skin, observation of the tongue, colour of eyes – both iris and sclera, the posture, the gait on walking, facial expressions, the colour of urine and any discharges, as well as skilled and thoughtful palpation of the tissue, the moisture of the skin, feeling the temperature, feeling and reading the pulse, smelling the general odour, hearing the tone of voice, hearing the heartbeat or the lung sounds, the crepitations (crackling) in the joints, the gurgling of the stomach. All of these, as well as a detailed case history allowed the physician/healer to make a highly accurate diagnosis. Of course, one needs to have a certain depth of knowledge and understanding to then be able to understand the significance of what the senses are reading, as well as the most appropriate treatment, but overall what we have is a truly holistic picture of the state of health of the person. Up until the 1950s, many physicians in the West still practised like this and with an understanding of the energetics of the disease process. Physicians who practised in the East within the systems of TCM, Ayurveda, and Unani-Tibb continue to practice under this paradigm. Their diagnostic skills have been maintained.
Touch is a human need. Babies crave it. Appropriately given, it soothes our nervous system, or it can stimulate it. It can convey a sense of belonging, and of being loved and cared for. We may think of the therapeutic touch of massage and bodywork. Yet, the diagnostic touch, the touch that conveys that someone is willing to spend time with you, is willing to listen to you -on all levels of your being- in order to most appropriately care for you, can also be therapeutic. We all want to be heard. We all need our pain acknowledged. Whether modern medicine thinks so or not, this acknowledgement forms as large a part of the healing process as the treatment itself.
I’ve come to this reflection on this diagnostic touch from my own nagging feelings of inadequacy, of something missing, spurring an eagerness to learn. When I did my training at college, out of the four or so years dedicated to the practice of Western Herbal Medicine, we did a grand total of two days dedicated to physical examination. Even then we didn’t use it much, nor were we encouraged to, in the 400 hours of student clinic. And reading the pulse or feeling the tissue for changes beneath didn’t come into it at all. But a lot of water has gone under the bridge since then, I’ve learnt much on the job, and I often find that when the time is right, things come into your world that suggest – either subtly or blatantly, that it’s time for further development. The personal upheaval of recent months has been such a time.
In my previous post, I mentioned that working with plants and making medicine is one of my coping mechanisms. Reading is another. I devour books almost insatiably. The first book that came into my world around this time was “Cancer: It’s Causes, Symptoms, and Treatment’ by the late, great American physiomedicalist, Eli Jones, MD. Published in 1911, it is as relevant today as it was back then. Perhaps more so. After spending the first two to three chapters lamenting the state of cancer treatment in regular (allopathic) medical practice, and indicting it all to shame, he then begins an emphatic treatise on the physician’s skill in correct diagnosis.
“He [the physician] must educate his hands — have his eyes at his fingers’ ends. The delicate, sensitive touch of the fingers will soon teach him how to detect cancer in any form….” (Eli Jones. Ch.5)
“In “taking a case” of cancer to treat we want to look the patient over carefully; ……
We examine the pulse of our patient; we find the pulse of cancer a weak pulse, often a discouraged feeling to it, and quicker than normal. The weight and feeling of the muscles show lack of nutrition. The tongue under its yellowish, white color shows, in advanced cancer a dark red color; in the last stages we have the “beef steak” tongue. The white of the eye has a pearly tint with greenish yellow spots, showing a drain upon the system, toxic matter in the blood and decomposition of albumen. The eyes will tell you if the glands are acting normally or not. The tongue shows you whether the patient is digesting his food or not; if he cannot digest his food, he cannot make good blood. The pulse tells you whether the vital forces are strong or weak. You must learn to study the quality and character of the pulse; until you can do that, you cannot cure this disease or any other.
Thus it is, by a careful intelligent study of the eye, tongue and pulse of our patient, we can get a good idea of the advancement made by the disease and the vitality of the patient; and this will be a guide to us in making up our prognosis and also for the rational treatment of the case.” (Eli Jones, Ch.6)
“Never forget the fact that the general health of the patient must be better before the cancer is any better. Watch the eyes, the tongue and the pulse; they will tell you of your patient’s condition. One of the first things my students have to learn is how to read the pulse. Not one doctor in a thousand can do it…. Grasp the wrist of your patient; banish every thought from your mind; think of what you are doing and what you want to know. How does it feel? What is the impression you get from the pulse? Remember the pulse of cancer has a weak discouraged feeling. It is a little faster than normal. If there is pain the pulse will show it, also if there is any heart difficulty. You can tell by the pulse if your patient is responding to the action of your remedies. The pulse will feel a little stronger, fuller and more regular. Remember that the healthy, normal pulse is full, strong and regular.”
I particularly like this admonition to his students;
“A doctor of all men should be a gentle man, and have an easy, gentle touch. I have had patients tell me how their physician pinched and squeezed the tumor in their breast until they screamed so that people could hear them out in the street. Such men are ignorant jackasses. I told these patients that they should have “slapped them in the face.” Such men need that kind of treatment. It is the only treatment that they can understand. In examining a case of cancer, it is hardly ever necessary to cause a patient a moments pain where a doctor understands his business. Treat your lady patients just as you would like a brother physician to examine you or examine your wife, sister or mother.”
Throughout the rest of the book, he then cites numerous successful case histories, along with his particular treatment protocols. The good doctor clearly knew his stuff and got extraordinary results. It’s a fascinating read and one which I will refer to time and again, and perhaps I will expound upon his work in some future article, but this idea of the importance of the physical examination, the diagnostic touch, to confirm a case spoke to me. Something was stirring, once spoken of, long forgotten, wanting to be heard once more.
Perhaps it spoke because of my own case of fibrocystic breast change. I’ve had it for about 9 years, managing to reduce it somewhat through various means including fasting, juice feasting, and dietary management, but never fully being ‘cured’ of it. Over the years it has changed character, largely influenced by hormonal cycles, that in themselves are an apparent barometer of whatever stress I have been going through. Recently, the character of the fibrous tissue and the cysts changed again. Using it as my own case study, I am acutely aware of the ‘eyes on the ends of my fingers’ as I palpate the changes and monitor closely the response to more accurately chosen remedies. It is often said that it is very difficult for the practitioner to self-diagnose, and an objective view must be obtained. Having said that, there is also the adage; “Physician, heal thyself.” Why pass up an opportunity for such intimate hands-on learning? It’s only through direct experience, that which we then can internalise, are we able to apply the knowledge gained with true, deep understanding and maybe a hint of wisdom. During my pregnancies, I learnt to feel the growth, and the positions of my babies, to listen to the heartbeat, and the whooshing of the blood coursing through the umbilical cord, as well as the difference between a ‘ripe’ and an ‘unripe’ cervix. I am, by and large, my own practicum, being curious by nature. But I digress.
As luck (or divine direction?) would have it, I came across another book for the hands-on aspect of diagnosis simply called ‘Hands On’ by Nic Rowley. It outlines in very easy to read and systematic detail the course of physical examination that any practitioner can employ (the subtitle is ‘Basic Clinical Skills for Students and Practitioners of Complementary and Alternative Medicine), and in a logical and what may become intuitive sequence. Although written much more recently than Eli Jones’ work, it borrows from the physical examination methods used in modern conventional medical practice (but devoid of observation of the tongue or reading of the pulse beyond counting it’s beats), and the author states that “if you have not got a pretty good idea of what is wrong with someone by the time they get on to your examination couch, you are unlikely to know what is wrong with them by the time they get off it”. This method of physical evaluation was what we were taught in that grand exploration of the subject during college. However, I think that despite the statement made above, not only does it’s offering still give our client the reassurance that we are leaving no stone unturned in their care, if we combine it with the careful visual and tactile observations of our tradition’s elders, then new information can be gained, and the case may be more fully rounded. After all, conventional medicine has left the concept of energetics and holistic practice behind, and as a result the most appropriate remedy. Unfortunately, in the modern practice of Western Herbal Medicine, particularly in this country, we are moving along the same trajectory. Nevertheless, it is a helpful book that reminds us that our senses are still among our best diagnostic tools. And even if we stop here with these ‘basic skills’, we can still determine likely differential diagnoses.
In his conversational tome, Traditional Western Herbal Medicine and Pulse Evaluation, co-authored with Phyllis D. Light and Francis Bonaldo, Matthew Wood reminds us;
“ In energetic medicine we view disease as a pattern. This is the basis of Holism, which looks to the unity in the diversity, the pattern that pulls together the disparate symptoms into a whole.
…In holistic medicine we believe – and everyday experience confirms this – that nature can cure herself. This is the primary difference between holism and biomedicine. But in order to make this belief a reality we have to pick up a different set of tools and approach the body from an entirely different perspective. Holism requires that we seek to understand the underlying problems that cause illness in the body such as heat and cold, damp and dry, tension and relaxation. If we can address these conditions before the disease has progressed too far, then we will be able to unburden nature and allow her to cure herself. Our understanding must be different and our tools must be of a different order.
…In natural, holistic, and energetic medicine our diagnostic tools must also be different. These include methods that help us to see the general patterns caused by stress in the body. We start with simple questions pertaining to hot and cold, damp and dry, tension and relaxation, basic emotions, aggravations and ameliorations. While we are asking questions, we are looking at the complexion of the face and skin, and then the signs of strength and weakness on the face (color, wrinkles, high spots, low spots, good hair, bad hair, etc.) Then we move on to methods that allow us to perceive very directly the imbalances in the body. This includes looking at the tongue, taking the pulse, and feeling the skin (for moisture, dryness, warmth, cold, oil, water, etc.) Pulse diagnosis is particularly suited to energetic medicine because the pulse reveals patterns of imbalance in the organism, not the sort of molecular lesions that constitute the evidence of disease in conventional biomedicine.
Such examination is usually enough for an experienced practitioner to draw conclusions about the origins of stress and disease within the organism. Then we select our therapeutic tools. These include exercise, nutrition, lifestyle, massage, bodywork, herbs, and homeopathic remedies. They must be suited to natural energetic patterns and changes in the body.”
This is the third book that happened to fall into my lap in recent weeks, and one that ran along with this theme building in my mind of the diagnostic touch. On first read-through I admit that I found it somewhat overwhelming. How in the world am I going to learn all of this? How in the world am I going to remember it all? There are no less than 22 different pulses that might be felt in 3 different positions on each wrist at three different depths representing the various organ systems, existing in pairs such as high/low, rapid/slow, tense, wiry/relaxed, slippery/non-resistant, strong/weak, etc., listed under the headings of dimension, time, tone, blood and vessel, and power. As well as the Southern blood types and the seasons of the blood noted by Phyllis. Even with a knowledge and understanding of the energetic model of Traditional Western Herbalism, and of the physiological processes of the body, it still seems at first exploration to be overwhelming. But how it has spoken to something deep within me! Pulse reading is akin to learning a whole new language. But then so was the materia medica of herbs when I first began learning them. These things become indentured over time, seasoned by practice. Even Matthew states; “ It takes decades to learn pulse diagnosis and, like herbalism, there is always more to learn.” I suspect that over this time, intuition will also develop alongside, much as it has with learning the herbs.
Phyllis D. Light picks up the thread;
“ The pulse is also that lyrical, throbbing, musical heart rhythm that sings the song of our body and soul. This is the pulse that I must explore. It is the cadence, depth, quality, breadth, speed, force and rhythm that invites me into the wrist to palpate the flow of the bloodstream, the river of life. Feeling the pulse against my fingers is one of the most important assessments of vital energy that I know.”
This is a book that I expect to be referring to over and over again as I begin to slowly train those ‘eyes at the end of my fingers’ to ‘see’ and really feel into the dynamics of the blood – that river of life – moving beneath them. Don’t be alarmed if I greet you now with “may I feel your pulse?”, rather than “hi, how’s it going?” It may take me a while to learn to really feel what it’s telling me but, in the meantime, I need lots of practice, so “may I feel our pulse?”
In this age of tech where even the idea of robots ‘caring’ for the elderly in nursing homes has been floated around, I fear that we are, quite literally, losing touch. Obviously for the practitioner – allopathic or holistic – mindfulness, empathy, and respect must accompany this ‘hands on’ tool. One must be aware of past trauma, or cultural taboo. This should go without saying and permission should be gained first. The diagnostic touch may also serve, however, as an educational tool. By explaining what you are looking for and why, the patterns that we are feeling and observing and how it all connects, we invite the client in to the conversation with their own body. We invite them to get in touch.
“By often feeling of the pulse….we may get the faculty of discerning the natural magnitude of the different constitutions, which no words can explain…” Sir John Floyer (1707)
I’m excited to add this tool to my practice, and to grow and develop with it in seeking a truly holistic framework for the wellbeing of my clients.
Jones, E. “Cancer: It’s Causes, Symptoms, and Treatment’. 1911. This book is available to read free online at https://planetherbs.com/research-center/cancer-book-resources/
Rowley, N. Hands On: Basic Clinical Skills for Students and Practitioners of Complimentary and Alternative Medicine. 2018. Aeon Books. London.
Wood, M. Bonaldo, F. & Light. P.D Traditional Western Herbalism and Pulse Evaluation: A Conversation. 2015. Lulu Publishing.
 If we read it without a knowledge of the time he wrote it, one might think that he was writing about the state of affairs today. The allopathic paradigm hasn’t changed in 100 years.