PICTURING THE PULSE

The pulse diagnosis laboratory is housed in a surprisingly sunny, spacious room hidden behind a massive aluminum door in the dim hallway of an austere Soviet-era research facility in Ulan-Ude, the regional capital of Republic Buryatia. Vitaly Vasil'evich, the current director, narrated to me the institutional history of the Automated Pulse Diagnostic Complex (APDC), the lab's primary scientific and technological invention, which has been in development since the early 1980s. He pointed to a framed poster hanging on the wall, a black and white photograph of one hand holding another, index, middle, and ring fingers resting on the inside of a wrist. By that point in my research, it was impossible to read the image without recognizing its citational quality: it is the classic representation, both in Buryatia and globally, of traditional Tibetan pulse diagnosis. Such images adorned promotional materials describing Buryatia's medical landscape. It is a reference to the region's cultural particularity as the home of one of Russia's ethnically Mongol and religiously Buddhist minorities. It readily indexed claims made by local government officials and medical institutions to having preserved and recently revitalized a local tradition of Tibetan medicine, with pulse palpation as Buryatia's distinct offering within Russia's vibrant sector of traditional medicine.Footnote ¹ Above the photograph, where the two hands faded into a burgundy background, its color symbolism deliberately Buddhist, ornate letters spelled out “Tibetan medicine.”Footnote ²

In the director's oral history of the pulse diagnosis lab, the poster figured as a memento of professional triumph. Its printing coincided with the 1990 visit of Dr. Tenzin Choedrak, who at the time served as His Holiness the Dalai Lama Tenzin Gyatso's senior personal physician. Dr. Choedrak visited the lab's clinical base at an Ulan-Ude hospital to observe the kind of scientific research on Tibetan medicine the region and the Soviet Union could offer. Once Choedrak was on site, the researchers capitalized on the opportunity and briefly recruited him into the role of consultant. To this end, he took patients' pulses alongside the APDC, which in the early 1990s was a set of wrist cuffs outfitted with six bulbous sensors connected to an archaic mainframe computer installation. Choedrak compared his diagnosis to the researchers' interpretation of the data the pulsometer generated. Vitaly Vasyl'evich recounted the doctor's reaction: “He became fascinated with the graph, the read-out of the pulse wave, and as it turned out, he had never seen the ‘pulsogram’ curve before. He listened very carefully to our descriptions and explanations, and when we explained what the [APDC] diagnosis suggested, he became really delighted, since it was just as his own. He then turned to the [Buryat] lamas accompanying him, and told them ‘You have to help these guys.’ We took it as a sort of blessing.”

It is difficult to say whether the Tibetan doctor's excitement was indeed due to seeing a pulsogram for the first time, or the result of the convergence between his own interpretation and that of the scientists testing the device, or was merely a polite performance of interest. Be that as it may, it is significant that the incident was a condensed moment of professional and scholarly success for Vitaly Vasyl'evich and his team. For the group of radiophysicists, engineers, and doctors working on “objectivizing” Tibetan pulse diagnosis in Buryatia, their main scientific achievement consisted in the ability to visually represent the pulse in line with the way it is used diagnostically by practitioners of Tibetan medicine. This, in turn, served to confirm that hard sciences could discern the foundations of an embodied and highly elusive therapeutic practice, and to demonstrate that there was more to the pulse than met the biomedical eye.

In Buryatia, diagnostic pulse palpation used by practitioners of Tibetan medicine, who are popularly referred to as emchi, typically does not produce medical texts, pictorial or otherwise, which circulate between specialists and institutions or are given to the patient to refer to during treatment. Local healers communicate about the pulse orally, and the conclusiveness of a pulse diagnosis is highly contextual, taken to depend on a practitioner's individual skill and level of spiritual enlightenment, and the constant fluctuations of a patient's bodily processes. For the physicists working on the APDC, producing the pulsogram became an opportunity to convert the event of pulse taking into an autonomous medical object. The possibility of “seeing” the pulse—rather than just hearing, feeling, and talking about it—would validate its diagnostic potentials for researchers interested in “objectivizing” Tibetan pulse reading, and allow the resulting image to circulate as a reliable record of a clinical event.

In this article I interrogate a project of mechanical standardization concerned with replicating the embodied skills associated with pulse diagnosis in Tibetan medicine. I draw on scholarship in medical anthropology that examines the scientization of non-biomedical therapeutic practices in order to analyze the layered histories of an imitative technological artifact in the making. Scholars have long noted that the task of incorporating “traditional” medical modalities into a biomedical mainstream is a process where Western scientific practices and methodologies frequently function as “gate-keepers” for what counts as valid forms of knowledge and evidence (Adams Reference Adams2002; Craig Reference Craig2011). Postcolonial studies have also documented the fraught encounters between Western techno-scientific and biomedical regimes and local epistemologies and practices (Anderson Reference Anderson2003), especially in places with no prior tradition of Western scientific thought. However, as anthropologist Vincanne Adams and her collaborators have argued, encounters between biomedical science and its “others” are never unidirectional (Adams, Schrempf, and Craig Reference Adams, Schrempf and Craig2011), and efforts to translate non-biomedical approaches and cosmologies sometimes reshape the very scientific regimes, diagnostic categories, and healthcare rationales that work to incorporate them (Adams, Dhondup, and Le Reference Adams, Dhondup, Le, Adams, Schrempf and Craig2011; Langwick Reference Langwick2011). The case of the pulsometer discussed here encourages us to also consider how such encounters play out when biomedicine itself is neither the primary nor the uniquely privileged interlocutor, and where separate disciplinary projects of making sense of bodies are made to align.

I employ insights of science and technology studies and anthropological analyses of medical imaging to suggest that the pulsometer project that emerged in the Soviet 1980s, and continues to this day, can highlight the troubled relationship between automation and mimesis at the heart of techno-scientific attempts to standardize embodied practices. Because the pulsometer materializes the confluence of distinct “epistemic cultures” (Knorr-Cetina Reference Knorr-Cetina1999)—those of physicists, physicians, engineers, linguists, and practitioners of Tibetan medicine—it reveals competing claims about what the pulse is, how one interprets it, and what actors are equipped to do so. Insofar as scientific projects are charged with epistemological commensurations, in this case, between “Tibetan” and “Western” medical models, or between tactile pulse palpation and electronic recordings of surface oscillations, they also identify, maintain, and technologically replicate meaningful distinctions. Scientists studying Tibetan medicine in the Soviet Union and Russia articulated and built upon a geography of rifts: the presumed physical and epistemological distances of “European” and “Asian” medical cultures and histories; the temporal separations of “modern” and “traditional” cosmologies; the distinct lived habits of therapeutic experts; and the gaps between bodies and machines. One important element of such commensuration projects is what I will here call “transduction ideologies.” Building on the concept of semiotic “transduction” (Silverstein Reference Silverstein, Rubel and Rosman2003; Keane Reference Keane2013), I track how theories of transposition across media—in this case the automation of a tactile diagnostic practice—produce commingled technological devices and social configurations.

Methodologically, I examine the institutional development and uses of the pulsometer in Buryatia alongside another Soviet-era imaging project concerned with non-biomedical healing. By tracking these parallel projects interested in “traditional medicine,” I locate the APDC in relation to a history of Soviet scientific efforts to articulate a developmental trajectory distinct from that of “Western” knowledge making and modernity (see Krementsov Reference Krementsov2006). Both Western and some Russian-language accounts of Soviet science have tended to focus on the peculiarities of Soviet and postsocialist scientific rationales and practices, either by pointing to the difficulties of transitioning to a research and design model (Yegorov Reference Yegorov2009) or by cataloguing the scandalously irrational “dead-ends” of a science distorted by the ideological demands of the state (see Joravsky Reference Joravsky2010; Graham Reference Graham1993).Footnote ³ By contrast, I explore the modernist visions offered by the Soviet projects investigating non-biomedical practices to excavate a scientific rationale that remained cautious of universalist narratives of cultural progress, and did not relegate “traditional” knowledge to either “non-science” or “nonsense.” I will explain how the pulsometer began its existence with the counterintuitive assumption that Western scientific thought was conceptually ill equipped to make sense of Tibetan pulse diagnosis, but that it could technologically replicate it with an imitative prosthetic device.

Through its historical and ethnographic biography, I explore how the pulsometer has partially subverted its own genealogies of automation by producing the very hindrances to commensuration that it is designed to transcend. In so doing, the device by necessity builds unexpected alliances across communities of experts. In turn, this process reveals how the production of authoritative (scientific) knowledge generates and maintains translational distances and uncertainties. I will argue that, in its current uses, the pulsometer enables a kind of evidence making in which the skills of traditional practitioners serve to authorize scientific research into Tibetan medicine.

“OBJECTIVIZING” TIBETAN MEDICINE

Buryatia's varied therapeutic geography comprises a diverse range of practitioners, from Buddhist lamas, shamans, and other traditional healers, to biomedical doctors, as well as experts who straddle these categories and resist easy classification. Within this geography, the ability to use the pulse for purposes of general diagnosis marks the professional identity of an emchi. This therapeutic setting is characterized by the proliferation of multiple forms of healing, which is often interpreted as the direct result of both scientific and biomedical regimes having lost legitimacy (see also Romanov and Yarskaya-Smirnova Reference Romanov and Yarskaya-Smirnova2007; Brown and Rusinova Reference Brown and Rusinova2002). Within this context, research into pulse diagnosis serves to establish a therapeutic expertise that offers one alternative to biomedicine and its discontents.

In Russia, most research projects organized around Tibetan medicine take for their main goal the “objectivization” and “deciphering”Footnote ⁴ of its textual canon and of the therapeutic skills of its practitioners. For researchers in this field, the problem is not one of establishing the efficacy of Tibetan medicine as a therapeutic modality. Most contemporary scholarly accounts published in Russia, particularly in Buryatia, argue that the question is moot. That Tibetan medicine in the region was never fully displaced by biomedicine despite periods of violent state repression is taken as proof of its medical efficacy (see Nikolaev Reference Nikolaev1998). Local researchers working with Tibetan medicine typically describe their activities as having two related components: developing ways to use Tibetan medicine to address healthcare needs of the population, and modern science to “crack its code.”

The latter orientation resonates with popular attitudes toward Tibetan medicine in Russia. Difficult to interpret in terms of familiar biomedical categories, Tibetan medicine is taken to simultaneously represent epistemic difference and contain “secret” knowledge opaque to “outsiders.” Popular literature and film on Tibetan medicine reproduces this sense of secrecy, and the title “Secrets of Tibetan Medicine” characterizes a number of works that promise to unravel its hidden message. The “cryptographic imagination” (Chadha Reference Chadha2010) of the Soviet and postsocialist scientific establishment and public was captured by Tibetan medicine as a set of textual artifacts salvaged and archived in the aftermath of Stalinist anti-religious repressions in Russia's traditionally Buddhist ethnic minority regions, and also as a local form of lived knowledge and practice. Interpreting Tibetan medicine is not exclusively the domain of basic research, be it in history, philology, or physics; these are in conversation with institutional initiatives to clinically deploy traditional medicine in Russia's state healthcare system. For almost three decades now, a central goal of scientific research into Tibetan medicine in Buryatia has been to develop the pulsometer and deploy it clinically.

Canonical Buddhist texts on Tibetan medicine, widely translated into Russian by Buryat scholars, discuss pulse diagnosis as a source of information that may speak to not just illness but also many other aspects of life. Each organ has its own pulse, and there are distinct characteristics in the pulses of different nyes pa—the three bodily constitutions, translated from Tibetan into Russian as either “origins” (nachala) or “culprits” (vinovniki) of both physical embodiment and illness. Pulse palpation, as described in the Tibetan medical canon, blurs the line between diagnosis and divination (Samuel Reference Samuel2006). Even when its focus is the body proper, pulse diagnosis skirts the materialities of tissues and organs and focuses on transient flows (Kuriyama Reference Kuriyama1999). For local patients, one appeal of Tibetan medicine, apart from widespread ideas about the naturalness of its pharmaceuticals and its appropriateness for treating chronic conditions, is the pulse diagnosis itself. When successful, patients often told me, the skilled practitioner can accurately weave together biomedically disconnected symptoms into a single, convincing clinical picture that takes into account a patient's personal illness narrative.

The experience of pulse reading thus contrasts sharply with the therapeutic encounters associated with a postsocialist healthcare system frequently described as “in crisis” (see Ol’khovskii and Tikhonov Reference Ol'khovskii and Tikhonov2010). Both patients and researchers often told me that a skilled emchi requires no complex medical technology or equipment, physiologically or psychologically traumatic interventions into the body, expensive or time-consuming tests, or team of experts to interpret the patient's ailments and medical history. In Buryatia, pulse palpation thus articulates a vision of medical progress toward better patient care. Government officials, physicians, and researchers frame its scientific and clinical potential in terms of redressing the perceived failures of Russia's national healthcare system, “modern” biomedicine, and the postsocialist condition generally. From this perspective, the relative success in developing and deploying the pulsometer in Buryatia appears counterintuitive since at first glance “objectivizing” pulse palpation would introduce exactly those elements of additional mediation that both researchers and patients identify as undesirable characteristics of the typical medical encounter.

The rest of this article will explore the questions that scientists working with the pulsometer have asked of the device in hopes of turning it into what philosopher of science Isabelle Stengers has called a “reliable witness” (Reference Stengers2000), a technical assemblage that can be mobilized to affirm the factuality of phenomena that are put into question, and to distinguish facts from artifacts. The emergence of “witnessing” as a key element of experimental procedure in the history of Western scientific thought has also been discussed by Shapin, Shaffer, and Hobbes (Reference Shapin, Schaffer and Hobbes2011), and Haraway (Reference Haraway, Galison and Stump1996). These authors highlight ways in which scientific objectivity in fact hinges on the social standing and moral orientation of the expert, called upon to “witness” the experiment. By contrast, I am interested in Stengers' observation that medicine frustrates its own experimental ambitions because the body frequently fails to function as a “reliable witness” to the scientific foundations of treatment; in her phrase, it can be “cured for the wrong reasons” (Reference Stengers2013: 16). I will argue that what is both messy and productive about the pulsometer is that, by failing to disentangle the multiple elements of its witnessing activity, it ensures that “wrong reasons” made apparent in the encounter between researcher, test subject, and device constantly reinscribe themselves into, and come to inform, the nature of scientific activity. To put it more concretely, as a measuring device at the research and design stage, the pulsometer is tasked with confirming that the pulse of Tibetan medicine might speak to more than blood flow in the ulnar vein and artery as expressing only the body's cardiovascular status. It was therefore designed to generate a technical image, a pulsogram, which could function as an index of multiple bodily processes and systems. Conversely, as a diagnostic tool in clinical settings, the pulsometer must produce information about recurrent and systematic bodily states—something that can be identified as illnesses—rather than ephemeral, circumstantial changes. As with any other measuring device, “data” has to be easily sortable from “white noise,” fact from artifact. However, throughout the local histories of its design and uses, the pulsometer has systematically merged the lab and the clinic. It has failed to disaggregate its role as a “witness” to Tibetan pulse diagnosis from its stated goal of automating and “objectivizing” palpation, such that one can confidently extrapolate from the pulse to the body. It is precisely this apparent failure that makes it a productive site for bridging the separate worlds of praxis of scientists, clinicians, and emchi.

FROM WITCHOLOGY TO RADIOPHYSICS: “TRADITIONAL MEDICINE” AND SOVIET SCIENCE

Here I will outline the history of the pulsometer's development in Russia, situating its emergence at the intersection between Soviet radiophysics and a popular interest in the possibilities of distance-healing that emerged in the Soviet Union in the early 1980s. Tracking these institutional histories illuminates the circulating technological ideologies to which the pulsometer owes its existence and longevity in institutional projects in Buryatia.

Research into the broad diagnostic properties of the pulse was not unique to the Soviet Union and was also taking place in China in connection to traditional Chinese medicine (Farquhar Reference Farquhar2013). Scientific and institutional connections between China and the Soviet Union regarding traditional medicine in fact predated the pulsometer. As historian Susan Buck-Morss has argued, Soviet ideology writ large was concerned with a particular concept of linear time, in which progress could be accelerated by eliminating “survivals” from previous stages of development (Reference Buck-Morss2002), including traditional and religious medicine. Yet by the late 1950s “Asian medicine” was credited with both the preservation of tradition and being therapeutically relevant for the present. In 1957, a group of neurologists from the Soviet Union's metropolitan centers traveled to China during a professional exchange where they were tasked with learning about Chinese acupuncture and bringing its methods back home. Relations with China soured by 1958, and scientific exchange was significantly reduced (Ratmanov Reference Ratmanov2010), but these collaborations enabled the foundation of what later became known as the Soviet school of reflexotherapy, institutionalized by the Soviet Ministry of Health in the Central Scientific-Research Institute of Reflexotherapy in Moscow in 1977. However, according to the researchers I interviewed, the pulsometer owes less to this legacy of dialogue around acupuncture and more to the laboratory management's proposition to draw from a Buryat cultural legacy and produce a unique device distinct from its Traditional Chinese Medicine counterpart. Curiously, a 1970s article in the American Journal of Acupuncture allegedly convinced local researchers that work on “traditional” medicine was not only important, but an emerging international field of inquiry in which Soviet science ought to participate.

The effort to mechanize Tibetan pulse-taking was started in 1983 in Ulan-Ude by a professor of physical and mathematical sciences, Dr. Chimit Tsyrenovich Tsydypov (1925–1991) and his team of researchers. Tsydypov was originally interested primarily in radiophysics but progressively expanded to include biophysics. The last project of his prolific research career became the “objectivization of the diagnostic methods of Tibetan medicine,” primarily through the development of the APDC. He articulated his research against the background of an emergent scientific field called “biomedical radiophysics, which brought together radiophysics and biophysics.” It was formulated by Professor Yuri Vasylyevich Guljaev, director of the Radio-Engineering and Electronics Institute of the Soviet Academy of Sciences, and Eduard Godik, head of the Radioelectronic Diagnostic Methods Laboratory in Moscow, and one of its goals was to scientifically investigate paranormal phenomena, namely Extra Sensory Perception. The project to study ESP was called “The physical fields and radiation of the human body.”

To understand the scientific culture and practices surrounding the pulsometer today, it is useful to look more generally at the “traditional healing” research undertaken in the Soviet state's political and scientific centers. According to Eduard Godik's memoir, in 1981 the Radio-Engineering and Electronics Institute's ESP project was prompted by a directive “from above” to figure out the scientific basis for “extrasensory perception” (Reference Godik2010). Godik, the lead scientist appointed to this task, explained the Communist Party elite's sudden interest in these distinctly “non-materialist” phenomena in terms of the stagnation of Soviet society in general and its ruling class in particular. Much as pre-revolutionary Russia had been fascinated with spiritism and the occult, Godik argued, so too were the aging party cadres of the 1970s and 1980s, and the Soviet population more broadly, captivated by the seemingly miraculous capacities of the extrasensy. Footnote ⁵

Godik was a graduate of the prestigious physics department of the Moscow State University who specialized in the properties of semiconductors, and he had little interest in what he jokingly referred to as “witchology.”Footnote ⁶ At this time the Soviet media was constantly hyping “unexplainable” phenomena like remote healing and telekinesis. Godik suggests that the political elite's panic concerning General Secretary Leonid Brezhnev's aging body brought this popular interest to scientific visibility and secured support, if not full financing, for research to discover the nature of the human “biofield.” “Biofield” is a shorthand term used in the popular media and among the lay population to describe a force field said to surround all animate matter, which might account for the efficacy of ESP healing and the various kinds of “information” it might contain.

This concern with “information” as a property of living organisms is entangled with the discourses of Soviet cybernetics. Cybernetics as a discipline was reviled under Stalinism, but by the late 1950s this attitude had reversed and cybernetics came to be seen as a conceptual bridge between disparate scientific fields like mathematics, physics, biology, and linguistics. Gerovitch (Reference Gerovitch2002) documents the establishment of “cyberspeak,” his term for a pidgin language in the scientific “trading zone” (Galison Reference Galison and Biagioli1999) that Soviet proponents of cybernetics hoped would eventually permeate all scientific domains.

Godik initially led a small team of young recruits selected from the state's top physics departments. Their goal was to show the “objective reality” behind phenomena that the general public and many academics were convinced were at work but contemporary science could not explain. They began by assessing the “biofield” problem by applying and perfecting techniques of remote sensing drawn from military and cosmic science. For Godik, the task was not to look for some unknown force but rather to concentrate on the known properties of living organisms, namely bioelectric activity and ensuing electromagnetic thermal radiation. Because of the variable electric conductivity of organic tissues (e.g., fat conducts electricity better than muscles do), it is difficult to find out what goes on inside the body by measuring its surface currents. Instead, Godik and his team used dynamic thermal imaging to measure surface electromagnetic radiation since it passes through living tissues more or less unimpeded (Godik Reference Godik2010: 21).

One case study from Godik's research reveals how the team's findings prompted them to ultimately turn to “Eastern medicine” as the next horizon of research. The team used dynamic thermal imaging to visualize and record the effects of remote healing, and monitored changes in skin temperature in patients suffering obliterating endarteritis of the feet caused by smoking. Having registered the gradual warming of the skin that followed the extrasens's hand movements, Godik formulated several working hypotheses. First, the improvement could be due simply to hovering palms emitting infrared radiation and acting as a “shield” against thermal loss, thus increasing the temperature of the area they moved over. This explanation appeared viable while the team worked with healthy patients, since there was no statistically significant difference between the changes in skin temperature induced by the healer's hand and by those of a “regular” researcher. But Godik had to reject this hypothesis when a seriously ill patient responded exclusively, and dramatically, to the healer's manipulations. At this point, Godik proposed a psychological explanation akin to the placebo effect: the extrasens might have subtly cued the patient's subconscious to self-regulate through a variety of nonverbal cues that accompanied the hand movements (ibid.: 43).

Godik's breakthrough came when the Chinese embassy asked the team to test an accomplished Qigong practitioner visiting the Soviet Union. Working with his hypothesis that an exchange of visual cues between patient and healer enabled the latter to psychologically “mobilize” the body's self-regulatory capacity, Godik proposed that the Qigong specialist position himself in the patient's field of vision. The practitioner declined to do so, and instead sat out of the patient's view. The recording equipment, trained once again on the patient's feet, recorded the changes in surface temperature as Godik silently signaled the Qigong specialist to begin or terminate his “influence.”Footnote ⁷ When the recorded changes matched the periods of “influence,” Godik was forced to reconsider his working model.

From his experiments with remote healing Godik drew several conclusions. First, the human body was a complex self-regulatory system and its capacity to “perceive” information was not limited to those signals it could consciously register. He hypothesized that an informational exchange beyond visual cues took place between patient and healer, and that this was a problem for psychologists and physiologists, not physicists. His second conclusion was that because contemporary medicine and science were becoming increasingly specialized they were ill equipped to conduct the kind of “systemic” interdisciplinary research the team had set out to do. Third, different senses were mutually imbricated, and the Qigong practitioner's skill seemed to suggest that the totality of sensory perception could be culturally organized in different ways, as well as trained. Godik gave pulse palpation as an example:

That other medical traditions offered radically different sensory assemblages—a conclusion Godik eventually used to explain his lab's findings—prompted him to turn from “spontaneous” and haphazard ESP to studying systematic skills. Since the effects of idiosyncratic healing abilities could be successfully “witnessed” through scientific means, and because his experiments suggested that other medical traditions could be consciously cultivated, Godik proposed “Eastern medicine” as the next direction for research at his laboratory.

MAKING PULSE WAVES: CYBORGS AND PROSTHETIC PALPATION

Godik was a logical intellectual ally and institutional supporter of Tsydypov's pulse automation project. The two had met in Moscow and had several follow-up phone discussions regarding the possibility of “automatizing” pulse diagnosis. Godik told me he was both supportive and enthusiastic (personal correspondence, 2011). After several administrative trips to the capital, in 1983 Tsydypov managed to secure approval for his new project in Buryatia. In its early stages, the pulse diagnosis lab had four researchers and one office doubling as lab space, and two stated goals: the “objectification of Tibetan pulse diagnostic methods,” and to understand “the influence of magnetic fields on the human body.”Footnote ⁸

The APDC project was initially met with skepticism from the local scholarly community. Tsydypov's research entered a domain of already active scholarship at the local Sciences Center, which had been ongoing for almost fifteen years, especially in the humanities, social sciences, and pharmacology. The critics came from different academic backgrounds but shared a surprising consensus about the risk of imposing “Western” scientific categories on Tibetan medical knowledge. A comment by a local philologist and recognized scholar of Tibetan medicine captures some of these tensions:

To some extent, scholars in the social sciences and humanities who cautioned their physicist colleagues against facile epistemological assumptions were preaching to the choir. From the beginning, the researchers working on the pulsometer accepted the idea that the pulse was not limited to reflecting the state of the cardiovascular system, and that appropriate explanations were available in the Tibetan medicine canon provided one could “decipher” it. While scholars charged with translating and interpreting primary sources on Tibetan medicine intimated that diagnostic palpation relied on a unique system of channels that did not quite map onto a Western biomedical anatomy (see ibid.), the physicists left the question open-ended. Tsydypov himself expressed this as follows: “We cannot yet state with confidence what is in fact the carrier of information about bodily states—is it only the mechanical movement of the arterial wall?” (Reference Tsydypov and Tsydypov1988: 17). With no larger project to interpret the “theoretical premises” of Tibetan medicine, what it meant by the pulse remained uncertain.

These conceptual difficulties did not halt the project; the researchers working on the device solved the impasse by suspending their concerns with what underlying bodily realities the pulse might index and focusing instead on replicating the palpation process itself. Scholars of the history of automation have noted that the boundary between the liveliness of machines and that of bodies is always troubled by the directionality of imitation and modeling (Riskin Reference Riskin2003; Johnston Reference Johnston2008; Helmreich Reference Helmreich2011; Stacey and Suchman Reference Stacey and Suchman2012). Technological artifacts tasked with modeling lively processes always risk reversing the relationship such that the automation of apparently “inanimate” machines becomes itself a model for how “animate” matter is understood to function. In the case of the pulsometer, the automation of an “animate,” embodied perceptive skill was conceptualized as possible precisely because it was already seen as isomorphic with machinic perception. At first glance, the design of the original pulsometer might look like an effort at biomimicry (Benyus Reference Benyus1997), not so much as an imitation of “natural” life, but rather as a mimetic replication of the emchi's bodily skill. To imitate, one needs a model, but also a transduction ideology: not only an “original” from which a copy is made—though we will see that this aspect figured prominently in the APDC's design—but also an organizing conceptual description of what processes are being imitated and how. For the physicists working on the pulsometer, the emchi's body, reduced to its relevant elements, was a set of precise sensors outfitted with an information-processing unit. The APDC at its inception was a “technomimetic” device: a machine imitating a body that was already understood as a well-honed, hypersensitive machine. In this way the physicists reversed the logic of how research into Tibetan medicine had been classically organized in Russia. Canonical texts could be used, not as theory to be decoded, but rather as an instruction manual for the emchi-machine.

My point here is that decoding and encoding the skill of the emchi already depended on viewing the practitioner as a kind of cybernetic organism. In invoking the figure of the cyborg, I draw on Donna Haraway's (Reference Haraway and Seidman1994; Reference Haraway, Galison and Stump1996) idea that the hybridity of the cyborg is one that rejects (or subverts) the utopia of primordial holism in favor of connections and the making of messy boundaries. On the other hand, it is precisely because Soviet physicists found cyberneticsFootnote ⁹ a useful epistemology that the APDC functions as it does. Scientists developing the device were not seduced by a promise of “holism,” since they accepted the idea that their model was one of multiple interconnected functions whose relationship had to be theorized and engineered in order to be approximated. Nor did they hope to extract certain aspects of the embodied knowledge and skill of the emchi but not others; good science meant that the totality of the insights and practices of the traditional practitioner could be replicated in a technological artifact.

Reverse-engineering the emchi's touch and thoughts meant that the researchers would try to envision what sorts of materials, electronic circuits, and physical phenomena might best “stand-in” for what the emchi was doing. In 1988, Tsydypov wrote that the trouble with trying to “extract information” from the pulse through technological means is that the pulse diagnostician “works in a sort of dialogical relationship: by varying the pressure, and the area of contact between the fingertips and the skin…, he alternately ‘interrogates’ the twelve internal organs; he then laminates the results of this ‘survey’ in his mind with the person's ‘congenital pulse’ and, taking into account the season and daily biorhythms, comes to a conclusion about the state of the patient's body in its totality” (Reference Tsydypov and Tsydypov1988: 7).

The first task before tackling the problem of interactivity was to determine what the sensors that stood for the diagnostician's fingertips would in fact “sense.” By reproducing the exact steps prescribed in the written canon on Tibetan medicine and recreating an electronic surrogate for the emchi's expert fingers as precisely as possible, one would presumably be able to record “data” without needing to know the nature of the phenomena being measured. The work of interpretation would come later, by mapping the resulting pulsograms against available methods of biomedical imaging and recruiting expert pulse diagnosticians to produce a database of corresponding functions, physical conditions, and constitutional types. To create the surrogate for the emchi's internal database the physicists needed the clinic. By the late 1980s, the project had a clinical base at the Republican Clinical Hospital for War Veterans, with a steady flow of test subjects and the collaboration of a few sympathetic biomedical doctors.

In practice, there is no way to build a device that is data-neutral, one that simply “perceives” without differentiation and does not already interpret. In order to engineer a sensing device one must decide what its sensors will be measuring. The APDC was grounded in the hypothesis that the emchi was reading and interacting with a “pulse wave.” Taking a wave as the analytical focus made the diagnostic properties of the pulse scientifically convincing, but complicated interpretation. A variety of factors may influence the characteristics of the pulse, including arterial blood pressure, the speed and intensity of cardiac contractions, and the elasticity and tone of arterial walls. Therefore, its textures would presumably be varied enough to account for the diversity of pulses that Tibetan medicine recognizes. In addition, because the pulse wave is reflected from vascular walls, and thereby interferes with itself, it created harmonics that, once accounted for mathematically and electronically, could be tied to a diagnostic scenario (Boronoev et al. Reference Boronoev, Ayusheeva, Garmaev and Zaiatuevich2012).

Physicists and engineers working on the pulsometer thus conceptualized the device as a kind of prosthetic augmentation that would reinterpret the emchi's embodied skill. It was thought of as a virtual enhancing extension—to elaborate on Elizabeth Grosz's discussion of prosthesis (Reference Grosz2005)—of a situated (Soviet, modern) body's inability or unwillingness to learn the sensory skill of the practitioner of Tibetan medicine. The emchi's tactile “biological sensors” (fingertips) converted the textures of the pulse into sound: “The Eastern doctor listens to the artery as if it were a string resonating with the various physiological processes of the organism” (Logvinov Reference Logvinov and Tsydypov1988). As a device enabling prosthetic palpation, the APDC had to replicate touch and make it legible to the eyes via sound in order to make the pulse diagnostically useful to modern Soviet subjects.

In order to “see” the pulse as an emchi would, in a diagnostically significant way, a series of mathematical and semiotic conversions are required. Researchers trying to produce the image of the pulse understood these conversions to already take place between the emchi's specially trained modes of sensing: from touch to hearing to seeing. An ideology of sensory transduction was thus crucial to the scientists' imagination of how the emchi interacted with the “pulse signal,” and how science could replicate and improve on it. Here, I draw on anthropologist Webb Keane's observation that the very act of transduction—the move between distinct “semiotic modalities”—has itself a certain efficacy (Reference Keane2013: 2). To automate pulse diagnosis, multiple transduction chains were necessary: skin oscillations had first to be recorded as a mathematical function with interpretable properties (amplitude, modulation, phase velocity, and so on), and then this function had to be transformed into a diagnostically relevant visual text. The resulting pulse image had value added both because it might serve as an autonomous medical object and because it worked to authorize pulse diagnosis. We will see in the next section that the pulsometer, founded on a project of cyber-mimetic replication of the emchi's skill, confers diagnostic authority by functioning as a sensory prosthesis that works to supplant the emchi's trained perception. Yet, paradoxically, it also relies on, and sometimes serves to produce, the legitimacy of Tibetan medicine as a valuable therapeutic modality, and authorizes the emchi as the only reliable arbiter of the device's accuracy.

THE CLOCKWORK EMCHI

Here I will ethnographically track the hopes, pleasures, and epistemological conundrums of using automated pulse diagnosis in present-day research and therapeutic practices in Buryatia. By the time of my fieldwork in Ulan-Ude in 2009–2011, several generations of the APDC had replaced their predecessors, and different versions were deployed for therapeutic and research purposes in at least four major medical and scientific institutions in the city. In its current incarnation, the device is a shiny white plastic box with a set of simple controls in the back: an on-off switch, a fan, a computer connection port, and two cables that extend about 18 inches from the metal panel. At the end of each cable is a set of white Velcro cuffs vaguely reminiscent of running shoes. Where they wrap around the wrists, the cloth material sections off into three strips that can be individually tightened. A solid block of plastic presses three spherical sensors, each about 1 centimeter in diameter, into the three pulse points on each wrist. Tightening or releasing the screws that run through each segment of the plastic block adjusts the pressure of these sensors. Each sensor records the oscillation of the skin above pulse points, and the six resulting oscillograms are analyzed by dedicated software.

I will present an ethnographic example of how this device and its technological descendants are employed in research and clinical projects carried out to address perceived shortcomings of standard biomedical practices in Russia. I focus on a series of experiments funded by a grant from the federal government under the aegis of the “Health Priority Project” (HPP), an initiative Vladimir Putin started in 2007 in response to dire findings of demographic and public health studies. The HPP was especially concerned with the health of Russian youth. The state saw the population's future health to be imperiled by harmful lifestyles, and called for regional programs that would address this. Scientists at the Institute for Innovative Technologies (henceforth IIT), an offshoot of the Department of Mathematics at a university in Ulan-Ude, obtained federal financing by arguing that “Tibetan medicine technologies” could help address national public health concerns by assessing the health of the university's students. The IIT research team asserted that this method would have two advantages. First, pulse palpation, and a few other diagnostic methods they mobilized, would be non-invasive, in contrast to common biomedical imaging technologies such as the X-rays, ultrasound, and electrocardiograms, or blood work. For Ayur, a thin, fast-talking mathematician and head of both the research project and the IIT, this “non-invasiveness” acquired a rich meaning beyond its typical association with procedures that stay on the surface without penetrating the skin. The second advantage was that Tibetan medicine technologies could find signs of disease early on and prevent their occurrence.

According to Ayur, students, and young people in Russia generally, are a risk group characterized by different health outcomes than the rest of the population because they have neither the time nor the desire to seek medical monitoring and treatment. He argued that “running from doctor to doctor,” a widespread behavior locally described as a pastime for the elderly and the idle, is not something students are willing to do. For Ayur, this avoidance of care was an indirect result of the perceived rudeness of doctors: he suggested that young patients often found the doctors they encountered judgmental and humiliating, and biomedical procedures tended to encroach on their privacy.Footnote ¹⁰ He saw Tibetan medicine as ideally suited to this population for the two reasons just discussed: “First, pulse diagnosis demands no invasive procedures, such as stripping down. Second, it can locate illness before it manifests itself clinically, and therefore prevent it.”

Ayur thought of students as a particular type of “patient in waiting” (Sunder Rajan Reference Sunder Rajan2006). Their illnesses were not yet apparent because of their youth and they were unwilling to look for signs of disease even if pathogenic processes were already subtly underway. Ayur and his team envisioned their research, in the long term, and once all their procedures were in place, as permitting mass monitoring of the university's students. It would discover what types of students are more susceptible to certain conditions and injuries, and help prevent these before they seriously impeded academic and athletic performance. The team also wanted to use Tibetan pulse diagnosis to assess demographic variations in health. The project would map the student population according to the “constitutional types” that Tibetan medicine describes, and offer students effective strategies for managing their health and diets. Ayur often self-identified as a “typical wind,” a pure expression of one of three primary constitutions Tibetan medicine recognizes.Footnote ¹¹ He blamed his afflictions on the predispositions of this socio-physical type, and offered his personal success with Tibetan medicine as proof of its effectiveness. When I began participant observation at the IIT lab, the research was still in its first phase. Its main goals were to calibrate all the technologies that IIT had obtained for mapping bodies, populations, and habits, and to determine what pulsograms could reveal about individual and collective subjects.

It is important to know that the data generated by the pulsometer, the pulsogram proper, is neither self-explanatory nor standardized to be easily read outside the event of its production. It requires translation and interpretation, as do many other kinds of medical images (Kevles Reference Kevles1997; Dumit Reference Dumit2004; Saunders Reference Saunders2010). It is an image of time—a profile of temporally aggregated pulsations represented through an oscillatory function—and its temporal nature has two sets of implications. First, it requires an interpreter to read the profile and reach broader conclusions about the body. For the purposes of clinical practice, the pulsogram must be converted into a schematic of the body's internal processes and states, such as a pie chart representing the status of internal organs. Second, unlike images that represent bodily spaces, whether static structures like the X-ray or frozen images of metabolic flow like the MRI, the pulsogram cannot produce a perfect iconic representation of the body. It requires a series of mathematical manipulations to reveal what it says in terms of the canonical literature on the properties of the pulse and the embodied experiences of the emchi's palpation. “Objectivizing” the pulse de-tethers it from the subjective comprehension of a specific practitioner at a particular moment of encounter. But it does not “objectify” it in the sense of turning it into an autonomous medical object able to speak “for itself.” At the center of the hopes and hype of deploying a “scientific” version of Tibetan medicine in Buryatia, then, is not the image of the pulse wave but rather the imaging technology, the device that generates the image.

At any given time some ten students squeezed into the long, narrow office. Ayur and his team occupied a lab space that followed a decidedly non-clinical research aesthetic. They donned casual clothing and cleared out ad hoc workspaces amid heaps of paper and assortments of electronic devices, wires, teakettles, and stained coffee mugs. Their work schedule was chaotic and seemed to express a kind of “experimental” temporality that was only loosely patterned on the university's academic rhythms. The students present were the first outside test subjects, following the initial calibration tests that the team had conducted on each other and on any passerby willing to volunteer their time and wrists. Most of these students were semi-voluntary participants, and came as a personal favor to Pavel, one of the graduate students working on the project who was also captain of the wrestling team. Pavel's supervisors expected him to be able to command team members' time and physical presence. Athletes were also “the usual subjects”; they are a typical research population at Ulan-Ude institutions for experiments that take Tibetan medicine as analytical framework, object of study, and therapeutic methodology. For the IIT researchers these students were an invaluable group because the diagnostic technologies used to classify their bodies interpreted them with a predictable bias. Pavel described to me the predominance of red in the color-coded pie charts generated by the software that processes pulsometer data: “athletes run a bit hot,” which is in Tibetan medicine a diagnostic category indicating a departure from a balanced bodily state.

While Pavel recorded these readouts, the students moved between measuring stations. At one of them, Sergei, a senior project collaborator, waited with another incarnation of the device. At that time, this new prototype of the pulsometer, called the “Computerized Pulse Diagnosis” (CPD), was a small steel box made from the case of a gutted computer hard drive. It was linked to a notebook computer dedicated to running the software that interpreted the pulse wave. The CPD has a single sensor in the form of a white earpiece from a pair of headphones, repurposed to function as a microphone. This sensor was to record the pulse wave acoustically rather than as vertical movements of skin over the pulse points. Sergei was a physicist who had worked for Tsydypov's lab but then moved to a different city and became a practitioner of Tibetan medicine himself. He developed his new pulsometer based partly on his experience with the APDC and partly from an extensive study of Tibetan and Sanskrit classical texts on Tibetan medicine. He used the CPD in his practice to mark himself as a specialist in Tibetan medicine and to provide his patients with medicines, advice, and recommendations about changing their lifestyles to improve their health.

Tsyrenma and I sat at different ends of a desk set away from all the wires and screens. My job was to take the students' blood pressure (allowed me after initial suspicions about whether “Americans” knew how to use blood pressure monitors), while Tsyrenma sat with only a pen and pencil. She is an emchi, classically trained in Tibetan medicine by one of the locally recognized Buryat keepers of the tradition. At the time of my fieldwork she practiced at a Buddhist temple in Ulan-Ude.

The researchers I interviewed never explicitly said that the ultimate goal of the pulsometer research was to replace the emchi. Rather, they wanted to develop pulse reading that was independent of them, and thus more widely available and more reliable. The cooptation of the traditional practitioners' knowledge and skills was nonetheless implied, and securing their cooperation was a matter of personal connections and luck. Tsyrenma agreed to help Ayur with his research after a mutual acquaintance recommended her to him as an ideal consultant: a trained and licensed general physician sympathetic to the scientific enterprise. When I asked her how her biomedical training influenced her everyday practice at the temple, she would laugh dismissively and say she had forgotten most of it. Her role was to palpate the students' pulses as they circulated between the five stations, each of which was monitored by a team member. Two stations administered versions of the pulse diagnostic system, another had a Voll electroacupuncture reader that measures skin conductivity in acupuncture points on the hands and feet, another had a thermometer, and the fifth a blood pressure monitor. The data collected was then compiled into a database and all of the results, including Tsyrenma's insights, were checked against all the others for consistency.

Ayur's research team took consistent deviation—along the lines of athletes running “hot”—to be a significant research finding. This allowed the researchers to typify certain bodies and populations. Something about what athletes did made their bodies consistently different, a difference that “Tibetan medical technology” could identify in a predictable, if somewhat ambiguous way as “heat.” And yet consistency of results always threatened to slip into the realm of diagnostic irrelevance. For example, Lydia, one of the senior mathematicians on the team, often puzzled that the thin young women occasionally recruited to participate in the tests showed “cold in their kidneys” and an excess of “wind.” Lydia articulated a recurrent doubt that plagued the researchers: “For some reason the girls are always nervous when they come in; maybe that's what we're seeing.” An emchi might conjecture that excessive nervousness, in combination with a thinner body type, was in fact the symptom of an underlying “wind” condition and therefore find the diagnostic relevance of the pulse unchanged. But Lydia's comment presupposed the possibility that the experimental setting evoked a kind of observer bias that would cast doubt on the diagnostic reliability of the machines. In this sense, researchers on the IIT team were constantly aware that their tests might be muddled because the act of machine-mediated diagnosis, however non-invasive, could still contaminate the research space with associations with an unpleasant clinical encounter.

Moments of corroborated data were also important in light of the constant sense of epistemological vertigo created by using a single device for longitudinal studies. In the initial phase of the experiments, each device was tested for how it performed over time on a single subject. The results were consistently inconsistent, fluctuating widely depending on the intensity of the pressure on the sensors and on various minute, temporary, and often intractable bodily changes that the researchers attributed to things like digestion, caffeine levels, breath, fatigue, or psychological ease. Pavel explained to me that one of the more immediate goals was to test the devices themselves to determine which were most reliable. Although the pulsometers effectively produced oscillatory graphs, which were subsequently converted into pie charts or histograms that described a test subject's health, the diagnostic relevance of the final image still had to be vetted via all the other technologies at the team's disposal. For Ayur's team, a consistency of outputs across devices eased the anxiety of not knowing which measurements were significant. Despite the stated goal of discarding inaccurate devices, none of the machines were ever eliminated for being insufficiently precise, and when I returned to the field in 2011 the team was still using all of them side by side to establish the diagnostic significance of a reading. Tsyrenma also continued to collaborate with the team, which secured her a place as a co-author of their publications.

Ironically, the mimetic aspect of the initial pulsometer (the APDC) was a key source of anxiety and irritation for the IIT researchers. Ayur and his team hoped to eventually replace this genealogically older machine with Sergei's newer prototype, not only because they felt that it was smaller and more portable, but perhaps more importantly because ownership of the APDC was contested. While the university owned an APDC unit, Ayur saw the APDC as really belonging to its original developers. This claim of ownership extended far beyond the rights to use the device and threatened to “taint” any research carried out with it, put its originality into question, and raised suspicions of plagiarism. IIT researchers frequently emphasized the specificity of their methods in an effort to distinguish both themselves and the research carried out at the Sciences Center's pulse diagnosis laboratory. The strong link between the machine and those who originally developed it also extended to the newer pulsometer, the CPD, such that the IIT was actively working to hire Sergei on a more permanent basis, and not only to purchase a prototype from him.

This strong connection between the developer and the device is a curious feature of the pulsometer, and hints at the place of the embodied expertise of the emchi in the transduction ideologies embraced by the scientists and clinicians who work with the machine. A reliable measuring device, provided it is used in accordance with instructions, is expected to perform similarly, with a known margin of error, independently of location or the research design that deploys it. By contrast, neither the old nor the new pulsometer prototypes were so easily alienable from the people and institutions that had made them.

I suggest that development of the pulsometer as a technology for the standardization of measurement has been upset by the device's prosthetic nature. As Ayur explained, the APDC was designed to imitate the fingers of the emchi. In its ideal form, the pulsometer would enable a virtual standardization of an embodied skill that could never be standardized in practice. After all, in the practices of knowledge transmission in Buryat Buddhism in general, and Tibetan medicine in particular, it is accepted that different emchi are not fungible, and not all students are equally talented or diligent. Nonetheless, the original device attempted to faithfully replicate an abstract emchi's palpation: the three sensors on both cuffs stand for the fingertips of the practitioner, and the device hardware and software are the emchi's mind. Therein lies the difficulty. Ayur's explanation of the hindrances to “objectivizing” pulse reading touches upon the impossibility of perfect technological imitation. When I asked him what the pulse diagnostic complex in fact records, he began by explaining how the process happens for a practitioner: “Imagine when the emchi applies pressure to one of the points, he is sending a ‘wave’ to the body, which gives a response. Based on the type of response he gets, he calibrates the pressure of his other fingertips to get more information. The practitioner does a systemic analysis in his head to determine what's wrong with the person, and issues a diagnosis.”

One might say that Ayur and his team were articulating a subtly different transduction ideology about pulse diagnosis and the emchi-cyborg, one that implied that the pulse did not simply present itself to the practitioner, but rather had to be dialogically teased to the surface. The old APDC failed to approximate an interactive approach to pulse reading since it was not as accurate as the emchi because it was not as dialogical, and therefore Ayur was looking for a workaround. For him, the new prototype (the CPD), despite its not being a functional imitation of the emchi's body, was a closer approximation because its output depended on the level of pressure and reintroduced the capacity to vary it on the fly, and because it consequently required a significantly higher degree of embodied skill on the part of the researcher. However, as with the APDC, in order to read the pulsogram that the CPD produced one had to anticipate what one might find; that is, one had to know the conceptual categories of Tibetan medicine in order to adequately interpret the results. For this reason, Sergei was in the lab as much to carry out research as to train others in thinking with Tibetan medicine through the pulsograms his device generated.

In their therapeutic practices, emchi constantly adjust how deeply the fingertips are pressed into the flesh of the wrist in order to read what the pulse does in response to this pressure. This is in part because the pulse is an elusive tactile phenomenon. It can be absent on the surface but surge forth furiously at a different depth, or pulsate strongly at the lightest touch and disappear at the first pressure. It is described through different qualia: hollow, full, sticky, slippery, light, heavy. In turn, all of these qualities are diagnostically significant and not simply a problem of implementation and skill. Each side of the fingertip reads a different organ, such that, for example, an emchi must be able to catch minute differences in sensation between the left and right sides of their index finger in order to differentiate between the pulse of the lungs and that of the large intestine. Taking the pulse is very much a type of bodily knowledge, or what Csordas has called a “somatic mode of attention” (Reference Csordas1993).

This is a knowledge that seems difficult to verbalize. While I frequently asked practitioners of Tibetan medicine to describe the process of learning pulse palpation, Tsyrenma's reflections on the subject aptly capture the contradictions of the practice. She described it as both easy and hard: It is easy to memorize the different types of possible pulses described in the textual canon. But because each pulse appears different and singular at first, it is difficult to read from it more than the particular characteristics of a specific body at a specific moment, and thereby find something as patterned as a discrete illness. If the pulsometer generates epistemological vertigo, as in the IIT experiments, then so does the emchi's palpation.

Much of the emchi's embodied skill lies in the ability to distinguish pulse qualities at each pulse point and recognize them as particular kinds of processes in specific organs. According to the classical formulations of the Four Tantras (rGyud bzhi), one of the primary canonical texts of Tibetan medicine, the emchi takes the pulse by placing the index finger “on the skin,” the middle finger “on the flesh,” and the ring finger “on the bone.” One must be able to recognize a “wind pulse” (pul's vetra) or a “bile pulse” (pul's zhelchi) by qualities learned through tactile approximation and calibration with a mentor. To describe this, Tsyrenma resorted to an example: “Back in the day, in Tibet, emchi would teach pulse taking by making their disciples stand at a river crossing and take the pulse of every person that came along.” Tsyrenma learned by examining the flows of patients who came to consult with her teacher. She would take their pulse after him, and check whether she was able to feel the movements of the humors in the same way that he did. For emchi in Buryatia, knowing the pulse is first and foremost a matter of extended ethical practice that goes beyond repeated palpation and touches on the domain of religious being. When I talked with Tsyrenma's teacher, he reminded me that diagnosing by the pulse is also a matter of intuition, which itself might be an index of properly Buddhist subjectivity and embodiment.

None of the various versions of the pulsometer make such distinctions. There are no sides to the sensors, and the device relates similarly to any wrist it is attached to. It knows the rich textures of the pulse via one method only, by recording and analyzing an oscillatory function. The results are normalized against a database of possible pulses, and diagnosis is a matter of statistical averaging. Specialized software then converts it into something intelligible to a doctor or researcher: an image detailing the “qualitative functioning” of each organ. Within the acceptable standard deviation, calculated based on all previous uses of the device, the colors of the graphs stay green. The red and blue codes for heat and cold—terms that Tibetan medicine uses to denote the pathological modus operandi of different organs—are loosely translated by the IIT team as “hyper-” or “hypo-function.”

Over repeated trials, the pulsometer software was “taught” to interpret what the practitioners were palpating: different kinds of pulse waves were recorded and classified, and their characteristics analyzed and mapped against the conclusions of the emchi recruited to serve as experts. Yet, while there are several hypotheses, and even some degree of consensus, regarding what specifically an emchi bases his or her diagnosis on, the pulse remains elusive. There is no “theory” to describe the relationship between the “pulse wave” and bodily states, and no perfect mathematical formula that would adequately reflect or predict the pulse wave itself. “There is no algorithm that accurately describes blood flow,” Sergei would tell me when I asked about his mathematical manipulations of the pulsogram.

In practice, this uncertainty makes the presumed transductions of the pulse, from signal to pulsogram to clinical image to diagnosis, sufficiently self-explanatory only in terms of Tibetan medicine itself. In other words, far from making the embodied knowledge and skills of the traditionally trained emchi redundant, the pulsometer continues to require their close involvement, to validate its output, read the graphs, and relate them to relevant discourses on affliction. The routine task of the clinicians and scientists is to determine whether the device is being too sensitive, whether it is speaking of the body's actual processes or instead reacting to irrelevant fluctuations. What is the pulse a witness to? This is a question that practicing emchi are constantly asking themselves as they feel for the pulse, standing day in and day out at the river crossing.

In the IIT laboratory the traditional expert and the pulsometer affirmed the validity of Tibetan medicine as a privileged approach capable of remedying the pathologies of postsocialist healthcare and of addressing the state's concerns with the health of youth. Because both the pulsometer and emchi could recognize similar types of bodies and habits among the test subjects, they co-produced cohesive social diagnoses of the collective student body. At the same time, failures to obtain consistent results had implications for both the device and the practitioners. Some of these uncertainties are captured in a comment Tsyrenma made after an especially frustrating afternoon of inconsistent data. As we were leaving, she joked offhandedly: “Every time I'm here, I feel like they are testing me.”

While IIT scientists refigured Tibetan medicine as providing a privileged vantage point from which to apprehend and anticipate the “systemic” dysfunctions of bodies whose pathologies were not yet clinically legible, they also constantly undermined this vision by framing changes in data as always potentially technological “white noise.” This placed the traditional Tibetan medicine expert, in this case Tsyrenma, in a position of both heightened legitimacy and heightened vulnerability, as the only truly reliable source for authorizing the relevance of the collected data. At the same time, the pulsometer's failures carried over and could bring into question Tsyrenma's palpation skills and therefore her legitimacy as a talented practitioner.

CONCLUSION: THE PULSOMETER AS UNRELIABLE WITNESS

Since its inception, the APDC has been a surprisingly cosmopolitan machine, considering the Soviet state's selectively impermeable borders and the way that its internal flows were often impeded as well. Following Tenzin Choedrak's visit, a contract for collaboration and “expertise exchange” with Men Tsee Khang in India was drafted and signed, but it was forgotten in the tumult of the Soviet Union's collapse in 1991. Two years before, a large delegation of specialists from the Medical University of Huhhot (Inner Mongolia, China) had come to observe the pulse diagnosis lab and assess its findings. Several of the visitors were recruited to lend their expertise and the delegation's leader spent time testing his pulse diagnosis skills against the APDC.

Over its multiple incarnations, the pulsometer took many forms and the project recruited a number of technologies, devices, and specialists. Its plastic body, made in Novosibirsk, insulates the sensitive electronics from external interference and mechanical damage. In one of its earliest incarnations, the APDC's body was a metal Nescafe coffee can, a “Western” commodity gained in a rare feat of procurement in the Soviet economy of shortage and scarcity of foreign products. A laboratory in Ukraine makes its sensors, the black piezoceramic semi-spheres on the cuffs. Most of its microchips are imported from China or Taiwan. The software that handles the data is written locally, but processing that data originally required several large computer installations, what the lab director fondly recalls as “huge wardrobe-sized monsters.” With time, the pulse diagnosis lab acquired smaller and more efficient computers, and the cuffs were transformed from a pneumatic “sleeve” to adhesive Velcro. Only the original researchers remember the coffee can.

The device survived the turbulent early nineties and continued to develop. In 1993, the laboratory applied to Russia's Federal Bureau of Intellectual Property, Patents, and Commercial Orders for a patent, which it received in 1997. In 2005, the Russian minister of economic development and trade, Herrmann Graf, while touring to assess investment possibilities in the Russian Far East, visited the research facility and underwent diagnosis. After this visit, his team issued a favorable assessment of Buryatia's potential for developing tourism, and particularly “health tourism” related to Tibetan medicine. By 2008 the pulsometer had propagated beyond the walls of its original laboratory into other clinical and scientific spaces in Ulan-Ude, and the IIT lab received a federal grant to use it in research. When I returned to the field in 2011, Ayur and a colleague were actively discussing the possibility of designing a portable version, complete with an IPhone app, to turn it into a household item, as commonplace as a thermometer or blood pressure gauge.

In this paper I have asked what made the pulsometer so productive that it has largely transcended the situated histories of its development, has survived radical changes in political and economic regimes, and still manages to recruit allies from vastly different groups of experts. Over the last thirty years, researchers designing the pulsometer were concerned to make it speak of the body as would the emchi, but without having to rely on individual emchis' variable techniques and forms of lived experience. By pointing to its many technological and social entanglements, I suggest that what has made the pulsometer efficacious is precisely that it is maintained as an unreliable witness, one that requires constant recruitment of other experts, whether devices or people, to bear witness to itself. The trouble with the pulsometer, as well as the reason for its productiveness, is not just that the images it generates require authoritative interpretation, and indeed in that it is no different from any other modern medical imaging technology that relies on what Daston and Galison have called the “trained judgment” of the expert (Reference Daston and Galison2010). What is most striking is that it constantly defers the possibility of final and definitive interpretation, whether of the pulse or the body, and therefore mobilizes a number of allies in a gridlock of codependent authorization.

Although one of the pulsometer project's original goals was to circumvent the emchi's personal skill, the recurrent presence of practitioners of Tibetan medicine in the laboratory is not simply a matter of recalcitrant redundancy, but also a necessary extension of the device itself. I have tried to show that rather than making traditional experts superfluous through the perfect imitation and subsequent automation of their diagnostic abilities, the pulsometer has come to function as a prosthesis for the sensory conversions that scientists imputed to practitioners of Tibetan medicine. If the relationship between mimesis and automation is always threatening to reverse itself, the pulsometer performs its own ambiguous articulations, blurring the directionality of the prosthetic relationship. At the very least, it encourages us to think about how such devices orchestrate their own enhancement and extension through the actors and practices they are supposed to substitute.

For thirty years pulsometer researchers have systematically recruited practicing emchi to authorize the machine's data. Its transition from automation to autonomy as a self-sufficient imaging technology has remained perpetually over the horizon. In tracking the social lives of this device, I have tried to show that by asking certain questions about the pulse, the body, and the skills of Tibetan medicine practitioners, while skirting others, scientists involved with “objectivizing” Tibetan pulse diagnosis have inadvertently created a technological object that productively limits the very possibility of the extraction and standardization it is supposed to enable. In turn, it is precisely the pulsometer's failures at perfect standardization that allow it to buttress the legitimacy of Tibetan medicine as a lived practice in Buryatia.