Traditional Chinese Medicine Case Studies / Medical Discussions / Reference Articles for Clinical TCM Studies
Introduction: Zhang Zhongjing’s pulse methods are not merely theoretical overviews but are closely integrated with clinical practice. Today, we present an analysis by Mr. Gu Juezhong from Ningxia Medical University regarding Zhang Zhongjing’s “Xian Pulse”. Mr. Gu’s reasoning is clear and well-founded, providing us with a correct method for interpreting Zhang Zhongjing’s pulse theory.
Zhang Zhongjing’s pulse methods, as he stated in his preface, are theoretically based on the “Nine Volumes of Suwen”, yet they differ from the pure theoretical overview of the “Suwen”. Instead, they combine his clinical practice experience with the variations of pulse signs, organically integrating them into the pattern differentiation process, further developing and validating them through repeated clinical diagnosis.
His works, “Shang Han Lun” and “Jin Kui Yao Lue” (hereafter referred to as “Jin Kui”), title each disease with “Disease, Pulse, Syndrome, and Treatment”, closely linking diagnosis and treatment, setting a precedent for future generations.
However, many later pulse studies have presented pulse signs in an overly mystical manner, leading people into confusion, which is undesirable.
The author believes that to learn and study Zhang Zhongjing’s pulse methods, one must deeply understand the content of each classic text, distilling the essence while discarding the dross, and adopt the scientific viewpoints and methods of pattern 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 the Relationship Between the “Xian Pulse” and Pain Syndromes in “Shang Han Lun” and “Jin Kui”In Zhang Zhongjing’s “Shang Han Lun” and “Jin Kui”, there are approximately 30 passages related to the “Xian Pulse” and the diseases, pulses, and syndromes associated with it. Many of these passages are complex and even difficult to understand (some scholars believe that certain passages are not original texts by Zhang Zhongjing but were added by later pulse theorists—this remains to be verified).Here, we will 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 the Pulse and Syndrome of Taiyang Disease”, 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 San Cheng Qi decoction), which will inevitably lead to increased intestinal motility, spasms, gas, and other stimulating symptoms; at the same time, indiscriminately 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 Kui, Abdominal Fullness, Cold Hernia, and Food Stagnation, 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 sensation from the viscera enters the spinal cord via the visceral nerves, and through the spinal thalamic tract, it corresponds to the somatic nerves in the area of the affected 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 increases, causing vasoconstriction and increased pressure, resulting in a “Xian Pulse”.The author’s understanding of the above passages can also be supported by Articles 21 and 22 in “Jin Kui, Phlegm, Cough, and Disease”.For example, it states: “If the pulse is deep and Xian, it indicates internal pain from suspended fluid;” and “For those with suspended fluid, the Ten Jujube Decoction is the main treatment.”This indicates that the pain is caused by exudative inflammation in the flanks.The pain response manifests as a “Xian Pulse”, and varying degrees of pain can correspond to different natures and forms of single Xian pulses or combined forms such as deep Xian, tight Xian, or even hidden Xian pulses.For instance, in “Jin Kui, Abdominal Fullness, Cold Hernia, and Food Stagnation, Pulse and Syndrome Treatment”, Article 17 states: “If there is abdominal pain, the pulse is Xian and tight… it 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; the main treatment is the Da Wu Tou Decoction.”From the above texts, it can be seen that varying degrees of pain can present three types of combined Xian pulses: light pain may present as a Xian pulse; moderate pain may present as a tight Xian pulse; and severe, unbearable pain with cold sweat and cold extremities will cause the pulse vessels to constrict sharply, reducing the diameter (deep), and increasing pressure within the 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 Pulse”Various pulse study texts from previous scholars generally share a common concept in describing the characteristics of the “Xian Pulse”.The walls of the blood vessels in a “Xian Pulse” are strong (rigid, hard), the vessel walls are tense, and the internal pressure is high, resulting in 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 significant backward thrusting pulsation (in normal individuals, the chi pulse is generally low and flat).Descriptions of the “Xian Pulse” by various scholars include: “straight and long” (from “Suwen”), “shaped like a bowstring, unyielding upon pressure” (from “Jin Kui”), “like a taut string on a zither” (from “Pulse Classic”), “unyielding upon pressure, distinctly like pressing a zither string” (from “Treatise on Various Diseases”), and “straight through the middle, firmly pointing down” (from “Pulse Classic Errors”)—all of which 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 to 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 pattern differentiation and treatment theories is undoubtedly still quite challenging at present, which requires further research and exploration.Note: This article is excerpted from “Compilation of Academic Experiences in Ningxia Traditional Chinese Medicine”, compiled in 1986.Recommended Reads, click to read the original text:Liu Bingfan: Learning to Treat “Insomnia” Following the “Neijing”Wang Hongtu: The “Neijing” States: Skin Diseases Can Also Be Treated from the “Heart”//////////【 Read Previous Highlights 】#Introduction to TCM Collection #Twelve Meridians Explained #Donghai Medical Collection #Experience of Old TCM Practitioners #Wonderful TCM Formulas #Secret Formulas #Masters of Traditional Chinese Medicine#Famous Cases from Shang Han Lun #Selected Famous Cases from Jin Kui#Four Gentlemen Decoction #Etiology Assignment #Herbal Properties Assignment #Song of Herbal Properties for 400 Herbs #Medical Three-Character Classic #Daily Insights from Mentorship#Daily Insights from Mentorship on Theory, Methods, Formulas, and Herbs#TCM Serialization CollectionHe Ren Master: What is the Essence of Using Warming Meridians Decoction?Zhou Zhongying: Insights and Techniques from 60 Years of TCM Diagnosis (All Essentials) Ding Guangdi: Qianghuo Shengshi Decoction for Treating “Five-Delay Diarrhea” Unexpectedly, “Qinggu San” Really Treats Fever After Bone Fractures!Dan Zha San for Treating Hyperlipidemia (Including Four Prescriptions for Hyperlipidemia)Shanghai Shen’s Women’s Medicine 600-Year Family Secret FormulaMagical! A Wonderful Experience Using Ancient Formulas to Treat Tooth Decay! Ancient Formula “San Liang Ban” Quickly Cures Lumbar Muscle Strain!【Collect】Eight Prescriptions from Nanshi for Treating Insomnia, Hypertension, and Gastrointestinal Diseases!
