As early as the pre-Qin period, there were writings documenting the slippery pulse, such as in the “Su Wen: On the Essentials of Pulse” which states: “Slippery means excess of Yin Qi.” The explanation of the character “滑 (hua)” in the “Shuo Wen Jie Zi” is “smooth”. The author uses historical timelines as the “warp” and various classical medical texts, diagnostic literature, and pulse diagnosis works as the “weft”. Utilizing the reference book “Pulse Studies Compendium” [1], and employing electronic searches in the “Chinese Medical Classics” [2] alongside manual searches of original texts, the author aims to fill in gaps and retrieve discussions on the characteristics and clinical significance of the slippery pulse, establishing an Excel spreadsheet to archive the original texts, and then reviewing relevant annotations and literature for detailed analysis. This summarizes the development and evolution of the understanding of the slippery pulse by physicians across different historical periods.
Understanding of the Slippery Pulse in the Pre-Qin and Han Dynasties
The term slippery pulse first appeared in the “Huang Di Nei Jing”, which provides a clear and specific description of the characteristics of the slippery pulse. The “Shang Han Lun” further elaborates on the shape and physiological and pathological significance of the slippery pulse. (1) The first work to describe the characteristics of the slippery pulse is the “Shang Han Lun”. In the “Shang Han Lun: On the Method of Pulse Diagnosis, Part Two”, it states: “The pulse is slippery and sinking, what does this mean?” [3] “翕 (xi)” means to gather, to converge; “奄 (yan)” means suddenly. This indicates that the slippery pulse is large and vigorous, with a strong and alternating pulse that suddenly sinks away. (2) The “Shang Han Lun” also considers the slippery pulse to be a physiological state. It states: “Sinking is pure Yin, and gathering is pure Yang; when Yin and Yang are harmonized, the pulse becomes slippery.” [3] This sentence discusses the mechanism of the formation of the slippery pulse, where “sinking” refers to the internal organs, hence pure Yin, and “gathering” refers to the exterior, hence pure Yang. When Yin and Yang are balanced, the slippery pulse is formed, indicating that under normal physiological conditions, the pulse can be slippery. (3) The “Shang Han Lun” also considers the slippery pulse to be a pathological state. It states: “The Shao Yin pulse is slightly slippery; slippery means it is tight and floating, indicating Yin excess, and the person must have sweating in the inner thigh, indicating dampness below.” [3] This sentence discusses the slippery pulse in a pathological state, where the Shao Yin is inherently Yin, and the slippery pulse is Yang, indicating that the presence of Yang in the Yin signifies Yin excess. The thigh is part of the Shao Yin, and when Yang heat invades, it must cause sweating, hence dampness below. The “Shang Han Lun: On the Differentiation of the Jue Yin Disease Pulse and Treatment, Part Twelve” states: “If the slippery pulse is present with cold limbs, there is heat in the interior, and Bai Hu Decoction is indicated.” [3] The slippery pulse is Yang, hence this cold limb condition is Yang cold, resulting from internal heat.
Understanding of the Slippery Pulse in the Wei, Jin, and Northern and Southern Dynasties
The “Pulse Classic” by Wang Shuhe during the Jin Dynasty is a very important work on pulse studies, providing significant guidance for later physicians in learning and researching pulse diagnosis. It is also the earliest existing work on pulse diagnosis in China, laying a solid theoretical foundation for the development of pulse studies in later generations, and further refining the theory and methods of taking the pulse at the cun (寸), guan (关), and chi (尺) positions based on the “Nan Jing”.
The “Pulse Classic” first established the characteristics of 24 types of pulses and provided a more specific description of the slippery pulse. Later physicians generally inherited the understanding of the slippery pulse from the “Pulse Classic”. The “Pulse Classic: On the Characteristics of Pulses, Part One (Twenty-Four Types)” states: “The slippery pulse flows back and forth smoothly, alternating and changing, resembling the number of times it beats. (One says it is floating and has strength. One says it is slippery like it wants to escape.)” [4]. Here, “往来前却 (wang lai qian que)” means moving forward and retreating, and in this context, “前后 (qian hou)” corresponds to the front and back of the pulse diagnosis, where the tip of the finger is the front and the root of the finger is the back. Therefore, the slippery pulse should be felt as sliding back and forth at the pulse point, hence the description of alternating and changing [5]. This is the most specific and vivid description of the characteristics of the slippery pulse, with others generally inheriting the views of the “Pulse Classic”.
The “Pulse Classic” also elaborates on the pathological significance of the slippery pulse in four aspects: (1) The “Pulse Classic: On the Methods of Slow, Short, and Mixed Pulses, Part Thirteen” states that a slippery and agitated pulse indicates internal heat. The heat pathogen disturbs the blood, causing the blood to be restless, hence presenting a slippery and agitated appearance. (2) The “Pulse Classic: On the Diagnosis of Mixed Diseases, Part Two” states: “Slippery means ghostly disturbance.” [4] Here, “ghostly disturbance” refers to diseases related to unclear consciousness caused by “ghosts”, which later generations confused with other diseases, leading to the derivation of many diseases related to ghostly disturbances. This indicates that mental and emotional diseases can also present with a slippery pulse. (3) The “Pulse Classic: On the Diagnosis of Vomiting and Diarrhea, Part Fourteen” states that those with diarrhea can present with a slippery pulse, and their pulse is slippery and weak. Diarrhea indicates damp pathogens accumulating in the intestines, and prolonged diarrhea must harm the body fluids, leading to the pulse appearing slippery and weak. (4) The “Pulse Classic: On the Diagnosis of Wind Stroke, Part Five” states that if a person has a headache and the pulse is slippery, it may indicate a stroke. Why is this said? Wind is known for its ability to move and change frequently; when the blood is disturbed by wind pathogens, it must flow smoothly, hence the slippery pulse can be observed. The above four points are the discussions of the pathological significance of the slippery pulse as seen in the cun pulse in the “Pulse Classic”, combining pulse signs to arrive at these conclusions.
The “Pulse Classic” also first divided the slippery pulse into the cun, guan, and chi positions for discussion: (1) In the “Pulse Classic: Volume Two: On the Symptoms and Treatments of the Three Positions, Part Three” and the “Pulse Classic: Volume Ten: On the Upper and Lower Yang Pulses”, both discuss the slippery pulse at the cun position, both agreeing that a slippery cun pulse indicates fullness and reversal in the chest. (2) The slippery pulse at the guan position often indicates heat accumulation in the spleen and stomach, hence a slippery guan pulse indicates the presence of pathogenic heat in the stomach. (3) The slippery pulse at the chi position often indicates the lower jiao kidney, hence a slippery chi pulse indicates fullness of blood and Qi; in women, it indicates obstruction in the menstrual vessels, while in men, it indicates hematuria.
Understanding of the Slippery Pulse in the Sui, Tang, Song, Jin, and Yuan Dynasties
During this historical period, various physicians inherited the understanding of the slippery pulse from the “Shang Han Lun” and the “Pulse Classic”, such as in the “Liu Zheng Huo Ren Shu” and the “San Yin Ji Yi Bing Zheng Fang Lun”, all of which believe that the slippery pulse indicates Yin excess, diarrhea, internal heat, Yang cold, fullness of the stomach, and food stagnation. Additionally, the manifestation of the slippery pulse differs between men and women; in women, a slippery chi pulse indicates obstruction in the menstrual vessels, while in men, it indicates hematuria. However, some physicians proposed new viewpoints: (1) The “Zha Bing Zhi Nan” from the Song Dynasty clearly states that the slippery pulse indicates heat syndrome, suggesting that a slippery pulse at the left cun indicates heart heat, at the guan indicates liver heat, and at the chi indicates heat in the kidney and bladder; while at the right cun indicates lung heat, at the guan indicates spleen heat, and at the chi indicates lower jiao heat, etc. [7]. This corresponds with the pulse positions in the “Pulse Classic” where the left cun, guan, and chi correspond to the heart, liver, and kidney, while the right cun, guan, and chi correspond to the lung, spleen, and mingmen. Since the pulse is the residence of blood, when heat pathogens occupy the pulse pathways, they stimulate blood flow, leading to a slippery pulse. (2) The “Zha Bing Zhi Nan”, “Yi Mai Zhen Jing”, “Mai Jue Kan Wu”, and “Mai Jue Zhi Zhang” all clearly state that the slippery pulse indicates phlegm. Phlegm is formed from refined fluids, and when phlegm and Qi are obstructed in the pulse pathways, it flows like beads rolling in a tray, hence forming a slippery pulse. (3) The “Zha Bing Zhi Nan” suggests that a slippery and gentle chi pulse in women indicates pregnancy. The chi pulse is the pulse of the kidney, which stores essence and governs reproduction; hence a slippery chi pulse in women indicates abundant Qi and blood, and when the pulse is slippery and gentle, it indicates a pregnancy pulse.
Understanding of the Slippery Pulse in the Ming, Qing, and Republic of China Periods
During this historical period, although physicians inherited many viewpoints from their predecessors regarding the slippery pulse, they also proposed new understandings. Firstly, regarding the characteristics of the pulse, the “Mai Jue Hui Bian” states: “The slippery pulse is alternating… resembling the meaning of lotus leaves holding dew” [8]. It describes it as a pulse that flows back and forth smoothly, resembling beads on a lotus leaf. The “Bin Hu Mai Xue” suggests that the slippery pulse should be distinguished from the rapid pulse, stating: “Do not confuse slippery with rapid; the rapid pulse is only observed in rapid intervals” [10]. The slippery pulse flows smoothly, like beads rolling, and its mechanism is due to the obstruction of evil Qi, stimulating the pulse pathways, hence it should be distinctly felt. However, when the fire heat pathogen affects the blood, causing accelerated blood flow, the pulse may also appear smooth and rapid, making it easy to confuse the two; hence, at this time, the rapid pulse should be used to distinguish, as the slippery pulse has four to five beats per breath, similar to a normal pulse, while the rapid pulse has six beats per breath.
In terms of the main disease characteristics, the main ideas of this period suggest that the slippery pulse indicates Yin excess, diarrhea, phlegm, internal heat, Yang cold, fullness of the stomach, food stagnation, obstruction in women’s menstrual vessels, hematuria in men, and pregnancy pulse in women, etc. The “Gu Jin Yi Tong Da Quan” suggests that the slippery pulse can also be seen in normal individuals, stating that a normal person’s pulse is slippery and weak, indicating the presence of stomach Qi, without disease. The “Mai Li Qiu Zhen” states: “A slippery and gentle pulse indicates no disease.” [9] This aligns with the viewpoint in the “Shang Han Lun” that a slippery pulse can also be seen in a physiological state.
However, some physicians proposed new viewpoints, such as the “Tai Su Mai Mi Jue” suggesting that if the cun, guan, and chi positions are constantly slippery, it indicates insufficient liver Qi. “Insufficient liver Qi” is rarely mentioned in clinical practice, which is determined by the physiological characteristics of the liver. The liver is a solid organ, being Yin in nature but Yang in function, and its nature is to rise and move. Hence, clinically, it is often seen as liver Yang rising or liver Qi stagnation. The liver also stores blood, hence liver blood deficiency is also common. However, modern scholars believe that the liver governs the flow of Qi, and when this function is diminished, it leads to the “insufficient liver Qi” syndrome. The liver governs the Qi mechanism of the body; when liver Qi is insufficient, its ability to regulate will also decline, leading to abnormal metabolism of body fluids and dampness accumulating in the pulse pathways, hence a slippery pulse can be seen in the cun, guan, and chi positions. The “Tai Su Mai Mi Jue” also suggests that if the chi position presents a slippery pulse, it indicates wind obstructing the tongue, heart heat, and vomiting due to stomach reversal. It is well known that the chi position mainly governs the lower jiao kidney; hence a slippery chi pulse indicates heat in the lower jiao. However, kidney Yin is the root of true Yin; excessive heat in the lower jiao harms kidney Yin, leading to malnourishment of the meridians, resulting in internal emptiness, and combined with external evil invasion of the meridians, the foot Shao Yin kidney meridian runs along the tongue, hence the tongue may appear strong. Kidney Yin nourishes the heart Yin; however, excessive heat in the lower jiao burns kidney Yin, leading to insufficient nourishment of heart Yin, causing heart fire to become excessive, hence heart heat is observed. Excessive heat in the lower jiao and insufficient kidney Yin also insult the middle jiao stomach, leading to vomiting and stomach reversal.
The “Mai Jue Hui Bian” also discusses the slippery pulse separately in the cun, guan, and chi positions, stating that a slippery cun pulse indicates phlegm causing vomiting; [10] a slippery pulse at the guan indicates heat in the liver and spleen due to food stagnation; [10] and a slippery chi pulse indicates damp heat descending to the kidney, bladder, and intestines, leading to symptoms such as thirst, diarrhea, and dysuria.
At the same time, the “Bin Hu Mai Xue” is the first work to clearly state that the slippery pulse indicates deficiency syndrome, stating: “The slippery pulse indicates declining Yang Yuan Qi” [10]. Why is this said? Phlegm and dampness easily present with a slippery pulse, and dampness is a Yin pathogen that easily harms Yang Qi. “Yuan Yang” is the root of all Yang Qi in the body; if dampness persists, it must harm Yuan Yang, hence a slippery pulse can be observed. The “Mai Li Qiu Zhen” states: “Qi deficiency cannot control Yin fire; a slippery pulse can be seen.” [9] This is another manifestation of deficiency syndrome presenting with a slippery pulse.
During this period, many works clearly state the viewpoint that pregnancy can be seen with a slippery pulse. For example: “A gentle and slippery pulse at the right chi indicates pregnancy, and intermittent slippery indicates menstrual obstruction”; the “Bin Hu Mai Xue” states: “A slippery pulse indicates declining Yang Yuan Qi… a woman’s pulse is regulated, indicating pregnancy” [10]; the “Mai Yu” states: “A woman’s chi pulse is slippery, indicating pregnancy”; the “Jing Yue Quan Shu” states: “A woman’s pulse is slippery and rapid, and the menstruation is interrupted, indicating pregnancy” [12]. Although physicians in various dynasties have discussed the slippery pulse indicating pregnancy, the Ming and Qing periods enriched this understanding. Physicians generally believe that if a woman has interrupted menstruation and a slippery and gentle chi pulse, it indicates pregnancy.
Understanding of the Slippery Pulse After 1949
In terms of pulse characteristics, modern scholars have inherited the discussions of the characteristics of the slippery pulse from their predecessors, while also standardizing and clarifying its content. In terms of clinical significance, modern scholars generally inherit the viewpoints of their predecessors and further specify their clinical significance, while also proposing some new viewpoints. When modern scholars study the slippery pulse, their understanding of the characteristics of the pulse is generally consistent with that in the “Huang Di Nei Jing”, “Shang Han Za Bing Lun”, and “Pulse Classic”; however, their understanding of the clinical significance differs and is expressed more specifically.
In understanding the slippery pulse, ancient physicians believed that the slippery pulse mainly indicates Yin excess, diarrhea, phlegm, internal heat, Yang cold, fullness of the stomach, food stagnation, obstruction in women’s menstrual vessels, hematuria in men, and pregnancy in women, etc., while the slippery pulse can also be seen in normal individuals. However, this general framework has not changed; for example, the textbook “Traditional Chinese Medicine” [13] states: “The slippery pulse flows smoothly, indicating roundness, like beads rolling; the main diseases are due to the conflict of evil and righteous Qi, Qi and blood stagnation, phlegm, food stagnation, and pathogenic heat; a slippery and gentle pulse can be seen in young adults and women’s pregnancy pulse.” The above viewpoints are generally consistent with the understanding of the slippery pulse by ancient physicians, but modern scholars have also proposed some new insights, such as: a slippery pulse can be seen in individuals who consume alcohol [14]; a certain amount of alcohol can dilate blood vessels and have a positive effect on the heart, leading to a state of Qi and blood surging, hence a slippery pulse can be observed; cardiovascular diseases can also present with a slippery pulse [15]; the slippery pulse indicates phlegm, and phlegm is caused by increased blood viscosity, leading to reduced blood flow in the cardiovascular system, hence causing cardiovascular diseases; during the rainy spring season, a slippery pulse can also be observed [16]; this is due to external dampness triggering internal dampness, leading to spleen dysfunction and accumulation of dampness into phlegm; pregnancy pulses are not all slippery [17]; the slippery pulse indicates abundant Qi and blood, but due to individual differences, a strong individual may have a slippery pulse during pregnancy, while a weak individual may have a weak pulse during pregnancy, rather than a slippery pulse.
Discussion
Modern scholars’ understanding of the slippery pulse is not entirely the same as that of ancient physicians. Ancient physicians believed that the slippery pulse mainly indicates Yin excess, diarrhea, phlegm, internal heat, Yang cold, fullness of the stomach, food stagnation, obstruction in women’s menstrual vessels, hematuria in men, etc., while the slippery pulse also indicates deficiency syndrome or a combination of deficiency and excess. However, modern scholars, in their understanding of the slippery pulse, tend to focus on the slippery pulse indicating excess syndrome while neglecting the understanding that the slippery pulse also indicates deficiency syndrome. In textbooks related to TCM diagnosis, the characteristic of the slippery pulse indicating deficiency syndrome is rarely mentioned. At the same time, physicians from different periods have varying understandings of the diseases indicated by the slippery pulse in the cun, guan, and chi positions, but overall, they tend to relate the pulse characteristics to the corresponding organs and diseases. Modern research indicates that the pregnancy pulse in women is not entirely slippery, but rather related to innate constitution and individual differences. Further in-depth exploration and research on these issues are needed in the future.
The slippery pulse is a common pulse type in clinical practice and often appears alongside other pulse types, hence attention should be paid to differentiating the slippery pulse and its common accompanying pulses, such as: slippery and rapid pulse; slippery indicates excess, rapid indicates heat, hence slippery and rapid pulses often indicate internal heat accumulation, cough, food stagnation, and abscesses; floating and slippery pulse; floating indicates exterior syndrome, slippery indicates phlegm dampness, hence floating and slippery pulses indicate wind-phlegm syndrome; sinking and slippery pulse; sinking indicates interior syndrome, slippery indicates phlegm syndrome, hence sinking and slippery pulses indicate food phlegm, hidden phlegm, and retained fluids; string and slippery pulse indicates phlegm dampness causing rib pain, as the string pulse corresponds to the liver and gallbladder meridians, hence string and slippery pulses can also be seen in liver Qi stagnation and pregnancy [18]; short and slippery and rapid pulse indicates excessive alcohol consumption, etc.; if a woman has interrupted menstruation, a slippery and gentle chi pulse that is also strong and smooth indicates abundant Qi and blood, indicating pregnancy without disease.
Slippery means flowing smoothly, like beads rolling, indicating abundant Qi and blood or internal excess; however, in individuals with chronic illness, a slippery pulse may also indicate a rapid pulse, which is a sign of impending loss of Yuan Qi. Chronic illness pulses are often Yin pulses, yet at this time, a slippery and rapid pulse appears, indicating a mismatch between pulse signs and a sign of impending loss of Yuan Qi. Mismatched pulse signs are often seen in critically ill patients or those with chronic illnesses, indicating a conflict between chronic illness pulses and the pulse signs. When mismatched pulse signs occur, careful consideration should be given to whether to prioritize the pulse or the signs, and comprehensive data collection should be conducted to avoid misdiagnosis or missed diagnosis.
Pulse diagnosis is a summary of the long-term medical experience of ancient Chinese physicians and is an important method in TCM diagnosis and treatment. However, TCM pulse diagnosis often depends on the physician’s subjective awareness and accumulated experience, lacking objective indicators and evidence. Therefore, modern technological means should be utilized to improve instruments and equipment, adopting objective methods to collect pulse information and conduct relevant pulse parameter analysis, aiming to obtain more accurate pulse information and avoid the influence of subjective factors during pulse diagnosis [20]. Currently, pulse diagnosis instruments can relatively objectively and accurately collect pulse information, but human pulse characteristics can change throughout the day, and the pulse manifestations of diseases can also vary at different times. Therefore, pulse diagnosis instruments should be improved to make them more convenient, aiming to achieve 24-hour dynamic monitoring of human pulse characteristics.
References
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[18] Li Shuilin. Research on the Diagnostic Significance of Common Composite Pulses Based on Literature and Clinical Evidence [D]. Nanchang: Jiangxi University of Traditional Chinese Medicine, 2019.
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[20] Li Xue, Qian Peng. Research and Clinical Application Progress of Pulse Diagnosis Instruments [J]. Chinese Journal of Traditional Chinese Medicine Science and Technology, 2017, 24(6): 826-829.
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Reference this article in standard format:Wang Xin, Nie Weichen, Chen Rui. Clinical Significance and Development of the Slippery Pulse [J]. Journal of Traditional Chinese Medicine, 2021, 27(6): 200-202.Authors: Wang Xin, Nie Weichen, Chen RuiAdapted from:Clinical Significance and Development of the Slippery PulseText Editor: Liu GuohuaNew Media Editor: Wen NanThis article was published on the new media platform of the Journal of Traditional Chinese MedicineThe views expressed in this article do not represent the views of the editorial department and editorial board of this journal!Unauthorized reproduction is prohibitedAll rights reserved, violators will be prosecutedCall for papers for the Journal of Traditional Chinese Medicine【Overseas Traditional Chinese Medicine】All manuscripts accepted by this column will have the opportunity to receivefree publication. Manuscript styles are not limited, content is not limited, themes can be self-selected, and it is recommended to be illustrated. Note:The final interpretation rights belong to the Journal of Traditional Chinese Medicine Official website: www.zyydb.comBusiness Cooperation Phone: 0731-85415606A
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