Continuing the discussion on pulse diagnosis
Previously, we talked about how the differences in understanding the physiological and pathological mechanisms of the human body lead to various perspectives on pulse diagnosis. However, these perspectives generally revolve around the concepts of Yin and Yang and the Five Elements. Some pulse diagnoses, such as those in the “Pulse Classic: Hand Examination Diagram of Thirty-One Parts,” are difficult to categorize from either the Yin-Yang or Five Elements perspectives, and their corresponding relationships can be quite challenging to comprehend. Therefore, they must be memorized and applied clinically.
Other pulse diagnoses, like the Four Seasons and Five Elements pulses in the “Yujizhen Zang Lun,” are also hard to understand from a modern perspective. Many interpretations from later generations can be overly simplified, such as equating the “Mao Pulse” directly with the “Floating Pulse,” which is a rather absurd notion. However, this misunderstanding can be attributed to the underlying issues of deficiency and excess, as the inherent definitions of deficiency and excess make it difficult to grasp the pulse diagnosis in the “Yujizhen Zang Lun.”
In summary, the definitions of deficiency and excess can be categorized into two major types and four minor types.
The two major types are deficiency and excess, and the extremes of excess and deficiency.
Deficiency and excess can be further divided into three minor categories:1. Zheng and Xie deficiency and excess2. Presence or absence of deficiency and excess3. Five Evils deficiency and excess
The extremes of excess and deficiency are a minor category: the excess and deficiency of Qi.
The definitions of excess and deficiency, as well as the Five Evils deficiency and excess, are based on the state of Qi and blood, similar to the application of Qi and blood; Zheng and Xie deficiency and excess, and presence or absence of deficiency and excess are based on the physical entities of Qi and blood, similar to the body of Qi and blood.
The pulse diagnosis in the “Yujizhen Zang Lun” is established based on the concepts of excess and deficiency. Therefore, when determining excess and deficiency, it does not rely on pulse strength to define deficiency and excess but rather on the presence and absence of Qi to determine excess and deficiency; similarly, the Five Evils deficiency and excess are not defined by pulse strength but by the Five Elements relationship between Qi and blood.
Of course, in clinical practice, there can be situations where the state-level deficiency and excess coincide with the physical-level deficiency and excess, making the problem relatively complex.
Ultimately, the core focus of pulse diagnosis is on logic rather than tactile sensation. Overemphasizing tactile sensation can lead to a mystification and vulgarization of pulse diagnosis, often resulting in claims of secret transmissions, with some even promoting ancient secret transmissions of pulse diagnosis that supposedly originated when people were still wearing animal skins.
Additionally, the so-called “pulse medicine” and “pulse prescriptions” can be confusing. While this approach is not without merit, it can easily lead to confusion. Why? Because the pulse is an effect, not a cause. Treating a cause with an effect is somewhat frivolous. For example, determining which herb to use based on a specific pulse is acceptable, but it is more important to clarify why that pulse presents itself. For instance, if the right cun pulse is floating and tight, must we always release the exterior? Can we release the exterior if only the left cun pulse is floating and tight? Therefore, we must clarify what causes this floating and tightness in Qi and blood, rather than simply correlating a specific pulse sensation with a specific herb, as this approach can lead to significant errors.
Returning to the “Deep Pulse” in the “Binhuh Pulse Theory,” the first issue is the experience of the tactile sensation of the “Deep Pulse.” Since the “Deep Pulse” is a typical positional pulse, its tactile sensation is not as crucial; the key is how to determine the “depth” of this “position.” The “Binhuh Pulse Theory” compares it with the “Hidden Pulse,” but the core still revolves around the concept of the “strongest point of force.” Once the concept of the “strongest point of force” is established, there must be a comparative object; one cannot simply compare it to a light pulse and claim that the deep pulse is stronger. Therefore, we need to establish a “neutral position” for the pulse. If the position of the “strongest point of force” is below the “neutral position,” we can define this pulse as a “Deep Pulse.” If the position of the “strongest point of force” is above this “neutral position,” we can define this pulse as a “Floating Pulse.” This tactile sensation issue centers on the comparative positioning of the “strongest point of force” to determine the “Deep Pulse” and “Floating Pulse”.
Of course, there is also the old issue of defining the concepts of “Floating Pulse,” “Floating with Pulse,” “Deep Pulse,” and “Deep with Pulse.” Here, a deep pulse does not imply that there is no pulse when floating; often, a deep pulse does not necessarily require treatment of the interior, as the person may exhibit a state of “Floating with Pulse.” Therefore, it is essential to view the pulse from a three-dimensional perspective rather than a two-dimensional perspective.
Next, regarding the main disease issue: this is relatively easier to understand. The deep pulse indicates a problem with the Yin channels, along with other accompanying pulses. For example, the text mentions the issue of “rapid, slow, slippery, weak, and strong” pulses, which generally indicates that when discussing the “Deep Pulse,” Li Shizhen emphasizes a perspective of “Zheng and Xie opposition,” focusing on the deficiency and excess of interior patterns, highlighting the presence of evil with “rapid heat, slow cold, slippery phlegm, deep and strong accumulation with cold” and the deficiency of Zheng with “weak and deep deficiency with Qi.” The logic is straightforward and easy to understand. However, this perspective of “Zheng and Xie opposition” can lead to some misunderstandings in treating the “Deep Pulse,” such as the deep pulse caused by “fire stagnation,” which may be better understood from a different perspective.
Since the “Deep Pulse” is a typical “pulse position” issue, we can attempt to understand it from perspectives related to “position” beyond just the “Zheng and Xie opposition” perspective, perhaps finding a better understanding. For instance, the perspectives of “Yin and Yang inclination” and “not in its position is evil”.
The perspectives of “Yin and Yang inclination” and “not in its position is evil” both belong to a purely “Zheng Qi” perspective. Therefore, when understanding the “Deep Pulse,” it should also be viewed from a purely “Zheng Qi” perspective.
From the perspective of “Yin and Yang inclination,” the core understanding of the “Deep Pulse” is that due to certain reasons, the “Zheng Qi” is inclined inward and cannot circulate between the upper and lower parts. Thus, there are two treatment approaches:
1.Remove the factors causing the Zheng Qi to incline inward, which is similar to the “Zheng and Xie opposition” approach.2.Directly guide the Zheng Qi to the exterior, restoring the circulation between the upper and lower parts. The focus of this approach is on guiding the flow of Qi, making the herbs that facilitate Qi flow very important. Typical representatives of herbs that guide Qi flow include Ma Huang (Ephedra), Xi Xin (Asarum), Du Huo (Angelica pubescens), Fang Feng (Saposhnikovia), Qiang Huo (Notopterygium), Bo He (Mint), Su Ye (Perilla), Qian Hu (Peucedanum), and Jie Geng (Platycodon); while herbs that provide energy to Qi include Fu Zi (Aconite) and Rou Gui (Cinnamon).
Next, from the perspective of “not in its position is evil,” the core understanding of the “Deep Pulse” is also that the “Zheng Qi” should circulate between the upper and lower parts but is now stagnated within. Therefore, its treatment is similar to that of the “Yin and Yang inclination” perspective.
The above is from the perspective of “position”; now let’s look at it from the perspective of “Zheng Qi and Xie transformation.”
If the pulse is deep within, from the perspective of “Zheng Qi and Xie transformation,” it may not exhibit evil transformation, such as “weak and deep deficiency with Qi,” but it may also show “evil transformation,” such as “rapid heat, slow cold, slippery phlegm, deep and strong accumulation with cold.” Of course, there is also the situation where “weak and deep deficiency with Qi” leads to evil transformation.
Therefore, the treatment methods from this perspective can be similar to those under the “Zheng and Xie opposition” approach (rapid heat, slow cold, slippery phlegm, deep and strong accumulation with cold), which addresses the already produced evil transformation; there are also methods that do not follow the “Zheng and Xie opposition” approach, which consider the root of evil transformation to be the stagnation of Zheng Qi, such as guiding Qi flow and providing energy to Qi; and there are also treatments targeting the evil transformation arising from “weak and deep deficiency with Qi,” which is a pure tonification and warming method, believing that the cause of evil transformation lies in the insufficiency of Zheng Qi, leading to the generation of evil Qi. In this case, the focus should not be on treating the evil Qi or guiding Qi flow, but rather on replenishing Qi and blood and providing energy to Qi and blood.
Of course, if we understand the deep pulse from the perspective of the Five Elements, it may not align with the above understanding.
For instance, a direct and simplistic understanding is that the deep pulse indicates a problem with the Kidney, which is discussed in both the “Nanjing” and “Suwen,” and its treatment methods differ from conventional approaches, such as using the “bitter tonification and salty purging” method for the Kidney, which greatly diverges from mainstream perspectives.
Of course, from the perspective of the Five Evils, the issue becomes even more complex, requiring the addition of classifications such as left heart, liver, kidney, and right lung, spleen, and life.
Thus, understanding the deep pulse from the perspective of Yin and Yang is much easier; however, from the perspective of the Five Elements, different views on deficiency and excess must guide the understanding.
Looking at the main disease poem for the “Deep Pulse” in the “Binhuh Pulse Theory,” it does not involve the corresponding descriptions of left heart, liver, kidney, and right lung, spleen, and life, but only addresses broader classifications such as cun, guan, and chi. This may suggest that under the perspective of the “Deep Pulse,” incorporating the Five Elements perspective could potentially broaden the possibilities. A wild guess would be that this is based on the “Zheng and Xie opposition” perspective rather than the “Yin and Yang inclination,” “not in its position is evil,” or “Zheng Qi and Xie transformation” perspectives.
Therefore, when we look at the section on “Hidden Pulse,” Li Shizhen concludes with a brief passage to elaborate on another interpretation of the “Hidden Pulse.”
“In cases of cold damage, if one hand has a hidden pulse, it is called single hidden; if both hands have a hidden pulse, it is called double hidden. One cannot diagnose Yin with Yang. This indicates that fire evil is internally constrained and cannot be released; when Yang reaches its extreme, it resembles Yin, hence the pulse is hidden, and there must be a significant sweat to resolve it.”
From the perspectives of “Yin and Yang inclination,” “not in its position is evil,” and “Zheng Qi and Xie transformation,” this becomes much easier to understand.