Lecture on the Slippery Pulse (Part One)
【Definition and Image】
The image of the slippery pulse resembles a series of rolling beads moving forward under the fingers, hence it is described as “resembling beads responding to the fingers” and “slippery as if wanting to escape”.
The slippery pulse is a type of abundant pulse, appearing when phlegm, food, or tangible evils are stagnant within the body. It is also known as the pulse of pregnancy in women, referred to as “胎脉 (tāi mài)” (fetal pulse).
Li Shizhen stated: “In women of childbearing age, if there is no illness and the pulse is slippery after menstruation, it indicates pregnancy.” Generally, the slippery pulse indicates phlegm and fluid retention. A floating slippery pulse indicates wind-phlegm, while a slippery and rapid pulse indicates phlegm-heat. A short slippery pulse indicates the disease of retained food.
【Differentiation from Similar Pulses】
Long pulse: The long pulse is characterized by being above the cun pulse and below the chi pulse, soft, even, and smooth.
Firm pulse: The firm pulse feels heavy and hidden, large and taut, appearing in very deep locations.
【Selected Literature】
From the “Treatise on Cold Damage”: “If the pulse is slippery and there is a feeling of tightness, it indicates internal heat; Bai Hu Tang (White Tiger Decoction) is indicated.”
From the “Essentials from the Golden Chamber”: “If the pulse is slippery and there is diarrhea, it should be treated accordingly; Da Cheng Qi Tang (Major Order the Qi Decoction) is indicated.”
This indicates that the slippery pulse belongs to internal heat or internal stagnation, which should be addressed with purgation.
【Diseases Associated with Slippery Pulse】
The slippery pulse represents the yang within yin, indicating phlegm, stagnation, and other tangible evils invading the body, which should be purged. The slippery pulse also indicates pregnancy, being the fetal pulse.
【Slippery Pulse with Other Pulses】
1. Slippery with Floating
(1) Slippery with floating, with a strong pulse at the guan position. The floating indicates wind, the slippery pulse indicates phlegm, and the taut pulse indicates stagnation; a strong pulse at the guan position suggests heat in the liver and stomach. Overall, this indicates external wind-heat and internal phlegm-dampness, with damage to both liver and stomach. Treatment should focus on expelling wind and phlegm while also draining heat from the liver and stomach.
(2) Slippery with floating, with a slightly rapid and thin pulse. The floating and slippery indicate wind-phlegm, while a thin and rapid pulse suggests internal heat due to yin deficiency. Overall, this indicates internal yin deficiency with stagnation of heat, and care should be taken to avoid further damaging yin while expelling wind and phlegm.
(3) Slippery with floating, with a soft and weak pulse. The floating and slippery often indicate wind-phlegm with heat. A soft and weak pulse may be due to damp obstruction or qi deficiency. Observation of the tongue and complexion is necessary to determine the treatment strategy.
(4) Slippery with floating, with a weak and rootless pulse at the chi position. The floating and slippery suggest wind-phlegm, while a weak and rootless chi pulse indicates insufficient root and qi deficiency. Treatment should consider tonifying qi.
2. Slippery with Deep
(1) Slippery with deep, thin, and weak pulse. The slippery pulse indicates phlegm, while the deep pulse indicates internal issues; a thin pulse suggests yin injury, and a weak pulse indicates insufficient yang. Treatment should focus on harmonizing yin and draining heat, with some tonification of qi.
(2) Slippery with deep, with a soft and weak pulse. The slippery and deep pulse indicates internal phlegm, while a soft and weak pulse suggests insufficient middle yang and qi deficiency. Treatment should focus on tonifying middle qi and expelling phlegm.
(3) Slippery with deep, with a thin and strong pulse. The deep and slippery pulse indicates internal phlegm and food stagnation, while a thin pulse suggests blood deficiency and yin injury. Treatment should focus on expelling excess.
(4) Slippery with deep, with a floating and tight pulse. The deep and slippery pulse indicates internal phlegm-dampness, while a floating and tight pulse indicates external cold evil. Treatment should use warming and dispersing methods, combined with phlegm-transforming herbs.
3. Slippery with Slow
(1) Slippery with slow, with a thin and deep pulse that is strong. The slippery pulse indicates phlegm, while the slow pulse indicates qi and blood stagnation; a thin pulse suggests yin deficiency, and a strong slippery pulse indicates phlegm and food stagnation blocking the vessels. Treatment should first open the bowels to smooth the vessels, then address the remaining issues.
(2) Slippery with slow, with a strong and slippery pulse. This pulse indicates mutual obstruction of phlegm and food stagnation, and treatment should begin with clearing and transforming phlegm and food.
(3) Slippery with slow, with a weak and soft pulse. This pulse indicates yang decline and qi deficiency, and treatment should focus on tonification.
(4) Slippery with slow, with a weak and soft pulse, and no chi pulse. The combination of slippery and slow indicates deficiency; a weak pulse indicates middle yang deficiency and qi deficiency; no chi pulse indicates early decline of the root. Treatment should use warming and tonifying methods.
4. Slippery with Rapid
(1) Slippery with rapid, with a tight and strong pulse. The slippery pulse indicates phlegm, while the rapid pulse indicates internal heat; a tight pulse suggests liver stagnation, and a strong deep pulse indicates excess heat. Treatment should focus on purging, but tongue diagnosis should also be considered for further refinement of herbs.
(2) Slippery with rapid, with a weak and soft pulse. The slippery and rapid pulse indicates phlegm-heat, while a weak and soft pulse indicates fundamental qi deficiency and damp obstruction. Treatment should focus on tonifying qi and transforming dampness.
(3) Slippery with rapid, with a weak pulse and a deep pulse that feels absent. The combination of slippery and rapid indicates phlegm-heat. A weak pulse and deep pulse that feels absent indicate deficiency of righteous qi. Treatment should focus on tonifying qi and nourishing yin, while addressing the root cause.
(4) Slippery with rapid, with a thin and weak pulse. The slippery and rapid pulse suggests deficiency heat; a thin pulse indicates insufficient yin; a weak deep pulse indicates qi deficiency. Treatment should consider the overall situation, referencing tongue, complexion, and symptoms for diagnosis.
(5) Slippery with rapid, with occasional skipping beats and a weak deep pulse. The slippery and rapid pulse with skipping beats suggests a rapid pulse; a weak deep pulse indicates middle yang deficiency and heart yang decline. Treatment should begin with tonifying yang.
5. Slippery with Taut
(1) Slippery with taut, with a thin and strong pulse. The slippery and taut pulse indicates liver stagnation with phlegm-dampness, and a strong pulse indicates excess evil. Treatment should focus on clearing and transforming phlegm-dampness and heat.
(2) Slippery with taut, with a slightly strong pulse and a rapid deep pulse. The taut and slippery pulse suggests heat and phlegm stagnation. A rapid deep pulse indicates mutual obstruction of heat and phlegm-fire. Treatment should begin with clearing and transforming phlegm-fire.
(3) Slippery with taut, with a thin and rapid deep pulse. The taut and slippery pulse indicates blood deficiency and yin injury, with mutual obstruction of phlegm-heat. A rapid deep pulse indicates internal heat. Treatment should clear phlegm-dampness, harmonize yin, and drain deficiency heat.
(4) Slippery with taut, with a weak and soft pulse that feels absent. The taut and slippery pulse indicates mutual obstruction of phlegm-heat and insufficient middle qi. A weak pulse indicates instability of the root. Treatment should focus on filling and tonifying.
(5) Slippery with taut, with skipping beats that are sometimes fast and sometimes slow. The taut and slippery pulse indicates mutual obstruction of liver heat and phlegm-dampness. The variation in speed indicates palpitations, which may be due to insufficient heart yang or internal fluid retention. Treatment should harmonize wood and earth while clearing phlegm-dampness, avoiding exclusive warming and tonifying methods.