To treat illness, one must seek its root. In Traditional Chinese Medicine (TCM), treatment requires the four examinations based on symptoms, analyzing the pathogenesis through these examinations, determining the syndrome type, establishing treatment principles based on the syndrome, and prescribing accordingly. Each step is interconnected and essential. The diagnostician employs the four examinations: observation (望), listening and smelling (闻), inquiry (问), and palpation (切); the analysis involves determining the pathogenesis and syndrome type. TCM diagnosis began with the Huangdi Neijing (Yellow Emperor’s Inner Canon), developed through the Shanghan Lun (Treatise on Cold Damage) and Jinkui Yaolue (Essentials of the Golden Chamber), refined during the Jin and Yuan dynasties, and completed in the Ming and Qing dynasties, continuously absorbing new diagnostic methods and progressing to this day.
This set of notes is my personal reflection on the university textbook TCM Diagnosis, presented in a different order than the textbook, containing my insights, experiences, and summaries. I am an amateur enthusiast of TCM, not a medical professional, so any errors in the text are to be expected.
(105) Slippery Pulse and Rough Pulse
Slippery pulse (滑脉, hua mai)
The description of slippery pulse in texts includes:“Flowing smoothly, like pearls rolling on a plate.”“Like dew resting on a lotus leaf.”“Flowing back and forth, smooth and agile, like pearls responding to fingers, slippery as if wanting to escape.”
Excess heat, fluid retention, blood stasis, qi stagnation, phlegm-dampness, and food accumulation can all cause a slippery pulse. A healthy person’s strong qi and blood, as well as a pregnant woman’s “joyful pulse,” are also considered slippery pulses. This makes it difficult to determine the cause of a slippery pulse in clinical practice, thus necessitating a comprehensive approach using the four examinations.
“Slippery indicates an excess of yin qi.”Phlegm-dampness accumulation, food stagnation, and fluid retention are all manifestations of internal yin pathogens. Excess pathogenic factors obstructing internally, with qi and blood surging, result in a pulse that is round, smooth, and free-flowing without obstruction. If the fire-heat pathogen affects the blood level, the blood flows faster, leading to a slippery pulse, but it must also be accompanied by a rapid pulse.
Slippery pulse and rapid pulse can easily be confused; in my experience, a rapid pulse is characterized by a high frequency of beats within one breath, while a slippery pulse may not necessarily have a high frequency but is always fast in speed. Therefore, a rapid pulse is assessed by pulse rate, while a slippery pulse is assessed by pulse speed.
The so-called slippery pulse like pearls rolling on a plate does not mean the shape of the pulse resembles pearls, but rather that the slippery pulse moves quickly like pearls on a tilted plate. If it resembles pearls in shape, it may be a bean pulse (豆脉, dou mai), a type of pulse in ancient pulse diagnosis.
Slippery pulse mnemonic:Slippery pulse like pearls rolling, flowing smoothly yet still forward. Do not confuse slippery with rapid, for rapid pulse is only about the number of beats.
“Rolling” means continuous and unbroken.
Rough pulse (涩脉, se mai)
Among the twenty-eight pulse types, this is the hardest to palpate.
Ancient texts describe rough pulse in many terms, making it increasingly difficult to understand. For example:“Rough pulse is thin and slow, difficult and scattered in its flow, sometimes stopping and then returning.” This indicates that rough pulse has five characteristics: thin, slow, stopping, scattered, and difficult flow. This is clearly a composite pulse pattern.
Later, ancient scholars stated:“Thin, slow, and short, all three characteristics are present.“Imbalance in the combination is called rough.” This means four characteristics: thin, slow, short, and imbalance in combination.
What does “imbalance in combination” mean? As a graduate in Chinese language and literature, let me explain: “参” (cān) is a polyphonic character with multiple meanings, includingshēn、cān、sān、cēn four pronunciations, each representing different meanings.
“参” (cān) and “伍” (wǔ) do not form a word, so this can be excluded.
“参” (sān) and “伍” (wǔ): either three or five, indicating an unpredictable number.
“参” (cēn) and “伍”: indicating intermingling and mixing..
“参” (cān) and “伍”: indicating an unpredictable number, can also refer to intermingling, and can also mean joining the army.
Many teachers read “三五不调” (sān wǔ bù tiáo), equating rough pulse with knotty pulse, which is a manifestation of cardiac arrhythmia. However, if one reads “参” (cēn) or “参” (cān) as intermingling, then rough pulse is equivalent to chaotic pulse.
In the Shanghan Lun: “Diarrhea with a floating and rapid pulse at the cun position, and a rough pulse at the chi position indicates the need to clear pus and blood.” In the Binhu Maixue (Pulse Studies of Binhu), it states: “The lung pulse is floating, rough, and short.” If a rough pulse is also slow, then the Shanghan Lun would be incorrect. If a rough pulse is characterized by “三五不调” (sān wǔ bù tiáo) or intermingling, then it cannot be the lung’s normal pulse.
My viewpoint is: regardless of how it is pronounced, it does not matter, as it is unrelated to rough pulse.
Rough pulse has only one tactile sensation, which is“difficult and obstructed flow.” The ancient descriptions such as “light knife scraping bamboo,” “like rain touching sand,” and “sick silkworm eating leaves” essentially describe this phenomenon of difficult and obstructed flow.
The formation of rough pulse may be due toqi deficiency failing to properly command blood, or due to deficiency of essence and blood failing to nourish the meridians. Alternatively, it may be due to cold-dampness entering the nutritive level, causing qi and blood stagnation. If the righteous qi is not harmed, the pulse is rough yet strong; if essence is damaged and blood is deficient, the pulse is rough and weak.
Modern medicine believes thatrough pulse is due to decreased cardiac output and slower heart rate, possibly related to vagal nerve stimulation. Slow blood flow and unfilled blood vessels, as seen in myocardial infarction, heart failure, and hemorrhage, lead to a pulse that appears present yet is not, seeming to stop yet not truly stopping. The ancient saying about rough pulse being associated with heart pain indicates that heart pain corresponds to modern myocardial infarction. It is also commonly seen in anemia, circulatory failure, and metabolic disorders.
What is meant by “light knife scraping bamboo”? Take a kitchen knife, find a bamboo cutting board, and hold the knife at a 70-80 degree angle to the board, almost vertical, and scrape. You will feel the intermittent resistance from the bamboo against the knife, which is what is meant by light knife scraping bamboo.
Rough pulse mnemonic:Difficult and obstructed flow.。