Introduction: Zhang Zhongjing’s pulse diagnosis is not merely a theoretical overview but is closely integrated with clinical practice. Today, we present an analysis of Zhang Zhongjing’s Xian pulse by Mr. Gu Juezhong from Ningxia Medical University. Mr. Gu’s reasoning is clear and well-founded, providing us with a correct method for interpreting Zhang Zhongjing’s pulse diagnosis.
Zhang Zhongjing’s pulse diagnosis, as he stated in his preface, is theoretically based on the “Nine Volumes of Suwen”; however, it differs from the pure theoretical overview of the “Suwen” by integrating his clinical experience, organically combining the changes in pulse patterns with syndrome differentiation, and has been repeatedly validated in clinical diagnosis.
His works, “Shang Han Lun” (Treatise on Cold Damage) and “Jin Gui Yao Lue” (Essentials from the Golden Cabinet), are titled for each condition as “Disease, Pulse, and Syndrome Treatment,” closely linking diagnosis and treatment, setting a precedent for future generations.
However, many later pulse studies have made the pulse phenomena overly mystical and speculative, leading people into confusion, which is undesirable.
The author believes that to learn and study Zhang Zhongjing’s pulse diagnosis, one must deeply understand the content of its classical texts, distilling the essence from the coarse, discarding the false and preserving the true, and adopting the scientific viewpoints and methods of syndrome differentiation and treatment, which is the correct scientific attitude.
This article aims to provide a rough exploration of the relationship between the Xian pulse and pain syndromes, to clarify this for fellow practitioners.
1Analysis of Xian Pulse and Pain Syndromes in “Shang Han Lun” and “Jin Gui” In Zhang Zhongjing’s “Shang Han Lun” and “Jin Gui,” there are approximately 30 passages related to the Xian pulse and its associated diseases, pulses, and syndromes. Many of these passages are complex and even difficult to understand (some scholars believe that certain passages are not original texts by Zhongjing but were added by later pulse theorists—this remains to be verified).Here, we will only discuss the relationship between the Xian pulse and pain syndromes.The relationship between the Xian pulse and pain syndromes can be summarized as follows:In “Shang Han Lun, Differentiating Taiyang Disease and Pulse Syndromes,” Article 140 states: “In Taiyang disease, if the pulse is Xian, there must be tightness in both flanks.”Regarding the general concept of Taiyang disease: When external pathogens (which can refer to various external pathological stimuli) invade the body, the first to respond is the Taiyang—Ying and Wei Qi, which rise to resist the pathogen, leading to symptoms such as chills and fever; this is the exterior syndrome known as Taiyang disease.The material basis for the exterior syndrome is the righteous Qi, and the treatment method is to assist the righteous Qi in dispersing the pathogen; as the pathogen is expelled, the righteous Qi can gradually recover.If purgative herbs are mistakenly used when there is no pathological accumulation in the intestines, the bitter cold herbs stimulate the intestinal tract (such as the Three Accumulation Decoction), inevitably leading to increased intestinal motility, spasms, gas, and a series of stimulating symptoms; at the same time, unjustly attacking the righteous Qi within will inevitably reduce the exterior’s resistance to pathogens, resulting in abdominal pain and even tightness in the flanks, thus presenting a Xian pulse.The formation of the Xian pulse is undoubtedly caused by pain.This can be further elaborated in the following classical texts.In “Jin Gui, Abdominal Fullness, Cold Hernia, and Food Stagnation Disease, Pulse and Syndrome Treatment,” Article 5 states: “If the pulse at the cun is Xian, there will be tightness and pain under the flanks, and the person will feel cold and shivery.”The sensation of pain generally occurs when tissues or organs are injured or stimulated by inflammation; in this sense, the sensation of pain has a protective significance.Based on the above two passages, it can be inferred that this pertains to visceral referred pain (Taiyang disease, purged) and inflammatory pain from the chest and abdominal wall.The conduction of pain from the viscera enters the spinal cord via the visceral nerves, and through the spinal cord and thalamic tract, it corresponds to the somatic nerves in the area of the organ.When inflammation is localized in the chest and flank membranes, due to the pain conduction centers being in the spinal nerves and autonomic nerves, the excitation of the sympathetic nervous system will increase, causing vasoconstriction and increased pressure, resulting in a Xian pulse.The author’s understanding of the above texts can also be supported by Articles 21 and 22 in “Jin Gui, Phlegm, Cough Disease.”It states: “If the pulse is deep and Xian, it indicates internal pain from suspended fluid,” and “For the disease of suspended fluid, the Ten Jujube Decoction is the main treatment.”This indicates that the pain is caused by inflammatory stimulation in the flanks.The pain response manifests as a Xian pulse, and varying degrees of pain can correspond to different types and forms of single Xian pulse or combined forms such as Chen Xian, Xian Jin, or even Fu Xian pulses.For example, “Jin Gui, Abdominal Fullness, Cold Hernia, and Food Stagnation Disease, Pulse and Syndrome Treatment,” Article 17 states: “If there is abdominal pain, the pulse is Xian and tight… this indicates a cold hernia. Cold hernia causes pain around the navel; if it occurs, there will be spontaneous sweating, cold extremities, and the pulse will be deep and Xian, indicating that the major Aconite Decoction is the main treatment.”From the above texts, it can be seen that varying degrees of pain can present three types of combined Xian pulses: light pain generally presents as a Xian pulse; moderate pain presents as a Xian Jin pulse; and severe, unbearable pain with cold sweat and cold extremities leads to a rapid constriction of the pulse, narrowing the diameter (deep), and increasing pressure within the blood vessels, thus forming a deep Xian pulse. This point has been practically experienced by the author in clinical practice.2Subjective Understanding and Preliminary Insights on the Xian PulseVarious classical pulse studies have a common concept in describing the characteristics of the Xian pulse.The Xian pulse is characterized by a strong (rigid, hard) vascular wall, tense vessel walls, high internal pressure, and a significant sense of resistance; the pulse at the cun, guan, and chi positions shows a forward thrusting pulsation at the cun, while the chi position exhibits a notable backward thrusting pulsation (in normal individuals, the chi pulse is generally lower).Descriptions from various scholars about the Xian pulse include: “Straight and long” (from “Suwen”), “Shaped like a bowstring, unyielding upon pressure” (from “Jin Gui”), “Like a stretched string” (from “Pulse Classic”), “Unyielding upon pressure, distinctly like pressing a string” (from “Treatise on Various Diseases”), and “Straight through the middle, firmly pointing down” (from “Pulse Classic Errors”)—all theoretically express the shape and characteristics of the Xian pulse.In addition to the aforementioned vascular factors, blood flow velocity, resistance to blood flow, and blood viscosity, some literature also mentions that increased levels of adrenergic neurotransmitters in the blood vessels and neurohumoral factors are also related to the formation of the Xian pulse. This connects with the pathophysiological process of sympathetic nervous system excitation triggered by pain syndromes.Thus, can we consider that: the Xian pulse is formed due to changes in the vascular wall, blood, neurohumoral factors, and endocrine activities.Therefore, establishing precise qualitative and quantitative standards for the Xian pulse and organically integrating them with TCM syndrome differentiation and treatment theories is undoubtedly still quite challenging, which requires further research and exploration.Note: This article is excerpted from “Compilation of Academic Experiences in Ningxia Traditional Chinese Medicine,” compiled in 1986.