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Source: Han Tang Jing Fang Reinheritance
In clinical practice, the use of twenty-six common pulse patterns and their combinations can summarize the complex and ever-changing pulse manifestations, essentially meeting the needs of “syndrome differentiation and treatment”. Therefore, the identification and analysis of these twenty-six common pulse patterns is fundamental for discerning and analyzing complex pulse manifestations.
To identify pulse patterns, one must master the normal pulse and be familiar with the normative shapes of the twenty-six common pulse patterns. This is the most important basis.
Secondly, one must grasp the correct operational methods and skilled techniques. Additionally, there are many methods that can be flexibly mastered, such as the methods of “classification of pulse patterns”, “mutual comparison”, “knowing the common to reach the change”, and “observing the unique”.
Analyzing pulse patterns involves a broad scope and is extremely rich in connotation. However, in general, it is based on the changes in pulse patterns to analyze the causes, nature, location, development trends, and pathological mechanisms of diseases, providing important evidence for “syndrome differentiation and treatment”.
The identification and analysis of pulse patterns are key steps in pulse diagnosis used in clinical practice, serving as a link and bridge for pulse diagnosis to participate in the process of “syndrome differentiation and treatment”. Throughout history, physicians have accumulated a wealth of experience. However, due to the neglect or misunderstanding of the normative shapes and practical significance of the twenty-six common pulse patterns, the identification and analysis of pulse patterns have been directly affected. For example, the leather pulse (ge mai) and the intermittent pulse (dai mai) primarily serve to identify and analyze changes or transitions in pulse patterns. However, their practical significance has been overlooked, and they have hardly played a role. Similarly, the moving pulse (dong mai) essentially represents a non-sinusoidal heart rhythm. However, due to its practical significance being buried, it has not played a role in diagnosing non-sinusoidal heart rhythms. These facts indicate that the methods and content for identifying and analyzing pulse patterns need further enrichment and improvement.
According to research, the twenty-six common pulse patterns carefully selected and determined by ancient physicians represent a rigorous and scientific combination that reflects not only the relevant aspects of the changes in the cun (寸) pulse but also various methods for identifying and analyzing complex pulse patterns. Moreover, these methods are practical, both simple and accurate. Therefore, these methods should be further enriched into current pulse diagnosis methods.
1. Identifying and Analyzing Pulse Patterns Reflecting Pulse Position
The pulse patterns reflecting pulse position are divided into four categories: first, the floating pulse (fu mai); second, the neither floating nor sinking pulse (bu fu bu chen); third, the sinking pulse (chen mai); and fourth, the hidden pulse (fu mai). The identification method is to first determine the finger strength used to press the cun position “to the bone”. Then, use the corresponding finger strength to identify which part the cun pulse is located. Based on the sequence of the cun pulse in the “five positions”, the changes in pulse position can be accurately identified.
For ease of discussion, we temporarily refer to the finger strength used to press “to the bone” as “total finger strength”. Based on “total finger strength”, one can specifically grasp the corresponding finger strength for examining each of the “five positions”.
For example: to identify the floating pulse, the finger strength used should not exceed “two-fifths of the total finger strength”.
To identify the sinking pulse, the finger strength should be greater than “three-fifths of the total finger strength”.
To identify the neither floating nor sinking pulse, the finger strength used should be between “two-fifths and three-fifths of the total finger strength”.
If the pulse cannot be touched with “total finger strength” and requires more than “total finger strength” to touch, it is the hidden pulse. Using the above methods, the changes in pulse position can be accurately identified. Other pulse patterns that are based on changes in pulse position are all combined pulses. For example, the moist pulse (ru mai) is “fine and soft” combined with “floating”, while the weak pulse (ruo mai) is “fine and soft” combined with “sinking”. Again, the pulse being floating and rapid (mai fu shuo) is a combination of the floating pulse and the rapid pulse, while the pulse being sinking and rapid (mai chen shuo) is a combination of the sinking pulse and the rapid pulse. Clearly, these are very accurate identification methods.
In analyzing changes in pulse position, it is generally believed that the floating pulse indicates exterior conditions, while the sinking pulse indicates interior conditions; this is a general rule. In clinical diagnosis, if the pulse for exterior conditions is not floating or the pulse for interior conditions is not sinking, its diagnostic significance is even more important. It is essential to analyze the general rules of pulse position changes and their special significance together to fully reflect the diagnostic significance of pulse position changes. For example, in the Treatise on Cold Damage (Shang Han Lun), Article 92 states: “If a patient has fever and headache, and the pulse is sinking, if there is no error, and the body aches, one should rescue the interior with the Si Ni Decoction (Si Ni Tang).” Article 301 states: “In Shaoyin disease, if it begins with fever and the pulse is sinking, one should use the Ma Huang, Fu Zi, and Xi Xin Decoction (Ma Huang Fu Zi Xi Xin Tang) to treat it.”
Both of these articles discuss “exterior conditions”, but the pulse is not “floating” but rather “sinking”. In this case, the comprehensive analysis of pulse and symptoms is very important. The previous article discusses a patient with fever, headache, and body aches, which belongs to the Taiyang exterior condition, and the pulse should be “floating” but is instead “sinking”, indicating a deficiency of Yang Qi and a heavier interior deficiency, hence the use of Si Ni Decoction to rescue the interior, which embodies the idea of resolving the exterior while rescuing the Yang. This illustrates that the Treatise on Cold Damage does not abandon the pulse in favor of the symptoms when “the pulse and symptoms do not match”, thus reflecting the guiding role of pulse position changes in “syndrome differentiation and treatment”. Article 301 discusses the Tai Shao two-sensation condition. The disease is in the Shaoyin, and it should not have fever but instead has fever, hence it is called “reversal”. This “fever” is due to the external invasion of wind and cold. The sinking pulse indicates that the heart and kidney Yang is insufficient to promote. The Treatise on Cold Damage does not arbitrarily take or abandon based on “the pulse and symptoms not matching”, but rather analyzes the pathological mechanisms within the “common” and “change” of pulse and symptoms, clarifying the internal reasons for the mismatch between pulse position changes and symptoms, and seeking appropriate treatment methods. The internal reason is the usual deficiency of heart and kidney Yang, which has again been invaded by wind and cold, hence the use of Ma Huang, Fu Zi, and Xi Xin Decoction to resolve both the exterior and interior. These examples illustrate that the analysis of pulse position changes should broaden one’s thinking and not be limited to the general understanding of “certain pulses indicating certain conditions”. If the pulse and symptoms do not match, a deeper analysis should be conducted.
2. Identifying and Analyzing Pulse Patterns Reflecting Changes in “Rate”
The pulse patterns reflecting changes in “rate” are divided into three categories: first, the slow pulse (chi mai); second, the normal pulse rate; and third, the rapid pulse (shuo mai). The complex changes in pulse rate in clinical practice can be categorized into these three types. Other pulse patterns that are based on changes in the “rate” of the pulse are all combined pulses. For example, the hurried pulse (cu mai) is a rapid pulse combined with “one stop at a time”. Similarly, the sinking and slow pulse is a combination of the slow pulse and the sinking pulse, while the sinking and rapid pulse is a combination of the rapid pulse and the sinking pulse.
The changes in “rate” are the easiest to identify and can be measured using the “breath counting method” or “timing method”. It is generally believed that the normal pulse rate is between four to five beats per breath. A pulse rate of three beats per breath or below is considered a slow pulse. A pulse rate of six beats per breath or above is considered a rapid pulse. According to the timing method, a pulse rate of less than 50 beats per minute is a slow pulse, while a normal pulse rate is between 60-90 beats per minute. If it exceeds the normal pulse rate, it is a rapid pulse. The pulse rate in children should be discussed separately.
In analyzing changes in rate, it is generally believed that the rapid pulse indicates heat, while the slow pulse indicates cold. However, this is merely the most general diagnostic significance of the slow and rapid pulses. Practical experience has shown that the slow and rapid pulses indeed have significant practical value in analyzing the cold and heat of diseases. In addition, the changes in pulse rate have broader significance. For example, organic and functional heart diseases, as well as pain syndromes, phlegm syndromes, and fluid syndromes, can all provide diagnostic evidence through changes in pulse rate. Especially in cases where “the pulse and symptoms do not match”, the analysis of changes in pulse rate is particularly important. For instance, in Article 213 of the Treatise on Cold Damage, it states: “In Yangming disease, if the pulse is slow, even if sweating occurs, and there is no aversion to cold, the body must be heavy, with shortness of breath, abdominal fullness, and wheezing, with tidal fever, and if there is a desire to relieve, one can attack the interior. If the hands and feet sweat profusely, this indicates that the stool has become hard, and the Da Cheng Qi Decoction (Da Cheng Qi Tang) is indicated.” This article discusses a slow pulse, which is neither deficient nor cold, but rather indicates a full heat condition in the Yangming bowel. In this case, it is essential to analyze the causes of the slow pulse and not simply consider it as “the pulse and symptoms not matching”. The reason for the slow pulse is due to full heat obstructing the interior, causing stagnation of Qi and blood, and the Yang Qi being restrained, which can also lead to a slow pulse. Therefore, the Da Cheng Qi Decoction can be used to purge the full heat and eliminate dryness and obstruction. This illustrates that traditional Chinese medicine has a unique understanding of the changes in pulse “rate” and must clarify the causes, nature, location, the diseases it indicates, and their interrelationships, and conduct a comprehensive analysis of the pathological mechanisms to fully reflect the diagnostic significance of changes in rate. Furthermore, the hurried pulse essentially indicates a rapid pulse with a “one stop at a time” change, indicating “Yang excess affecting Yin” or “extreme heat injuring Yin”, which is a method of understanding under the guidance of traditional Chinese medicine theory. This indicates that although the pulse rate is merely the number of heartbeats, under the guidance of traditional Chinese medicine theory, changes in pulse rate have very broad diagnostic significance. Therefore, the analysis of changes in rate should reflect the guiding role of traditional Chinese medicine theory while also considering that the essence of changes in rate is the variation in heartbeats, combining both aspects to better reflect the diagnostic significance of changes in rate.
3. Identifying and Analyzing Pulse Patterns Reflecting Size
The pulse patterns reflecting the size of the pulse are divided into three categories: first, the normal pulse size; second, the flooding pulse (hong mai); and third, the thin pulse (xi mai). The sizes of the pulses that can be felt in clinical practice fall into these three categories. Other pulse patterns that are based on the pulse being “large” or “thin” are all combined pulses. For example, the vacuous pulse (xu mai) is a large pulse combined with “slow, empty, soft”, while the minute pulse (wei mai) is a thin pulse combined with “soft”.
The identification of pulse size is based on the normal pulse size. If it is larger than the normal pulse size, it is a flooding pulse. If it is smaller than the normal pulse size, it is a thin pulse. The standard for normal pulse size varies from person to person and can be determined by referring to the method of dividing the “five positions”. For details, please refer to Chapter 6, which will not be repeated here.
In analyzing pulse size, it is generally believed that the flooding pulse indicates fullness and heat, while the thin pulse indicates deficiency. In fact, this is the general rule for the flooding and thin pulses. Moreover, both of these pulse patterns have very broad diagnostic significance. For example, regarding the flooding pulse, the Pulse Science Elucidation (Mai Xue Chan Wei) states: “If after a long illness there is deficiency, or if there is deficiency due to blood loss and this pulse appears, it is a bad sign of Yang excess and Yin depletion.” Although this pulse pattern is a flooding pulse, it does not necessarily indicate fullness; it can be confirmed as a true organ pulse indicating “stomach Qi has been exhausted”. Otherwise, it may not be a bad sign of “Yang excess and Yin depletion”. This illustrates that the diagnostic significance of the flooding and thin pulses cannot be generalized. It is essential to conduct a comprehensive analysis in conjunction with combined pulses and clinical manifestations. Ancient physicians determined the vacuous and full pulses as common pulse patterns, which is one aspect of the comprehensive analysis of the nature of the flooding pulse and its associated diseases. Therefore, based on the flooding pulse, one should further differentiate between fullness and deficiency, and not assume that all flooding pulses indicate fullness.
The analysis methods for pulse patterns and their associated diseases in the Treatise on Cold Damage and Miscellaneous Diseases are highly commendable. This method integrates pulse, disease, symptoms, and treatment, conducting a comprehensive analysis, and flexibly applying pulse diagnosis in clinical practice. This is the most significant method to reflect the diagnostic role of pulse diagnosis.
4. Identifying and Analyzing the Smoothness of the Pulse
The slippery (hua mai) and rough (se mai) pulses reflect the smoothness of the pulse. The smoothness of the pulse is divided into three categories: first, the normal smoothness; second, the slippery pulse; and third, the rough pulse. Among them, normal smoothness is a necessary condition for normal pulse patterns. The slippery and rough pulses indicate that the smoothness of the pulse has changed. Therefore, one can accumulate experience in identifying the slippery and rough pulses by understanding the comprehensive performance of the normal pulse.
The identification methods for the slippery and rough pulses are challenging to master. This is because the smoothness of the pulse must be judged based on various changes in the pulse. However, the purpose is not to examine other changes in the pulse but specifically to assess the smoothness of the pulse. Therefore, identifying the slippery and rough pulses is relatively difficult. The key technique is to press the finger on the ridge of the cun pulse and carefully observe the smoothness of the blood flow within the pulse vessel, then combine it with other changes for a comprehensive understanding. If the blood flow within the pulse vessel is smooth and more fluid than normal, it is a slippery pulse. If the flow is difficult and less smooth than normal, it is a rough pulse. The smoothness of the pulse does not have specific indicators; it is challenging to judge based on the comprehensive performance of the normal pulse. Therefore, one must strengthen basic practice and accumulate experience in examining the smoothness of the normal pulse to accurately identify the slippery and rough pulses.
In analyzing the slippery and rough pulses, it is generally believed that the slippery pulse and rough pulse are opposites, with properties that are directly contrary. However, their associated diseases and diagnostic significance should not be confined to the “opposite” or “directly contrary” forms. Some pulse texts habitually discuss pulse patterns and their associated diseases in terms of “opposite” or “contrary” forms, which indeed facilitates the distinction of pulse shapes and properties but does not accurately express the diagnostic significance of pulse patterns. Moreover, if one is confined to this form, it makes the flexible and dynamic pulse methods rigid and inflexible, which is not conducive to the important role of pulse diagnosis. For example, the diseases associated with the slippery pulse are mostly due to pathogenic fullness, but the diseases associated with the rough pulse can be either deficient or full, and one cannot assume that the slippery pulse indicates “fullness” and therefore the rough pulse must indicate “deficiency”. Furthermore, the diseases associated with the slippery pulse are not necessarily all indicative of fullness. Therefore, the analysis of the diseases associated with the slippery and rough pulses must be based on a specific analysis of the smoothness of the pulse and cannot be generalized.
5. Identifying and Analyzing the Tension of the Pulse
The tense pulse (jin mai) reflects the tension of the pulse body, which essentially indicates an increase in the tension of the pulse body. If the cun pulse has normal tension, it is generally considered a “slightly tense” pulse, which indicates the presence of stomach Qi and is specifically manifested as a tense pulse with a “gentle” appearance. Not all tense pulses indicate disease; there are distinctions between those indicating “normal”, “disease”, and “death”, primarily depending on the amount of stomach Qi, which can be identified based on the degree of “gentleness” of the tense pulse. The tense pulse indicating “disease” is the tense pulse with “less stomach Qi”. The tense pulse indicating “death” indicates that stomach Qi has been exhausted, representing the degree of a “true organ pulse”, hence indicating death.
The identification method for the tense pulse is: first, touch the pulse body, then apply pressure to the pulse body, with the finger feeling characteristics of “pressing like a bowstring”; if the finger is lifted, the pulse body does not rise with the hand. This is a manifestation of increased tension in the pulse body.
The tense pulse has a high occurrence rate, and historical pulse texts have recorded many instances of the tense pulse and its associated diseases. It is generally believed that there are physiological and pathological tense pulses. The physiological tense pulse corresponds to the liver pulse associated with the spring season. The pathological tense pulse is often caused by abnormal relaxation, Qi stagnation, and disharmony of Qi and blood. Its associated diseases are mostly related to liver and gallbladder disorders or cold conditions, pain syndromes, phlegm syndromes, Qi depression, Qi stagnation, blood stasis, mass accumulation, hernia pain, and spasms. In addition to some common diseases, fluid retention, hanging fluid, and other conditions are also associated with the tense pulse. The Pulse Classic states: “The pulse of malaria is self-tense”. The Pulse Science Elucidation states: “The pulse of hepatitis is often tense”. This indicates that ancient physicians’ analysis of the tense pulse and its associated diseases is closely related to common or frequently occurring diseases, continuously integrating new knowledge and gradually accumulating experience, rather than being confined to a rigid form of “matching pulse and symptoms”.
6. Identifying and Analyzing the Tight and Relaxed Pulses
The tight pulse and relaxed pulse are directly opposite in nature. The tight pulse essentially indicates that the pulse body is “tense” or “constricted”, while the relaxed pulse indicates that the pulse body is “relaxed” or “loose”. Both of these pulse patterns are pathological pulses, and there is no such thing as a “normal pulse”. The identification method is: the tight pulse has a “tense” or “constricted” pulse body, with a finger feeling characteristic of “bouncing left and right” or “like cutting a rope”. The relaxed pulse has a “relaxed” or “loose” pulse body, with a finger feeling characteristic of low “tension” or “elasticity”.
The relaxed pulse should be distinguished from the slow pulse. The Pulse Classic warns that later generations should not confuse the slow pulse with the relaxed pulse, and the preface specifically explains: “To take the relaxed pulse as slow will lead to imminent danger.” This serves as a reminder to later generations that the “relaxed pulse” and the “slow pulse” must be strictly distinguished. Otherwise, misdiagnosis and mistreatment may occur, even leading to serious consequences. The fundamental difference between the two is: the slow pulse examines changes in rate, while the relaxed pulse examines the degree of “relaxation” or “looseness” of the pulse body. They must never be confused.
The tight pulse should be distinguished from the tense pulse. The difference is: the tense pulse merely indicates increased tension in the pulse body, pressing like a bowstring. The tight pulse, however, indicates that the pulse body is “tense” or “constricted”, and has a “bouncing left and right” or “like cutting a rope” feeling. These two pulse patterns have certain differences in shape and degree. Therefore, the tense pulse can be either a normal pulse or a pathological pulse, while the tight pulse is always a pathological pulse.
Some pulse texts have misunderstood the normative shape and practical significance of the relaxed pulse, leading to some inappropriate analyses of the tight or relaxed pulses. For example, the Diagnostic Eye states: “The relaxed pulse is the stomach pulse, not indicating disease, and can only be diagnosed when combined with other observations.” In fact, this misunderstands the concept of “relaxed pulse” and “the pulse coming gently”. In reality, “the pulse coming gently” is the stomach pulse. The relaxed pulse is not the pulse coming gently; these are two concepts that must not be confused. Therefore, saying that the relaxed pulse “does not indicate disease” is incorrect, and saying that “it can only be diagnosed when combined with other observations” is also incorrect. For example, in Article 2 of the Treatise on Cold Damage, it states: “In Taiyang disease, if there is fever and sweating, and aversion to wind with a relaxed pulse, it is called wind stroke.” This is an instance of diagnosing based solely on the relaxed pulse. This illustrates that the Treatise on Cold Damage does not misunderstand the normative shape and practical significance of the relaxed pulse. Furthermore, in Article 3 of the Treatise on Cold Damage, it states: “In Taiyang disease, whether there is fever or not, there must be aversion to cold, body pain, and vomiting, with both Yin and Yang pulses being tight, it is called cold damage.” This article corresponds with the second article, indicating that the tight pulse and relaxed pulse are directly opposite in nature. Therefore, it is necessary to clarify the misunderstandings and misstatements regarding the relaxed pulse and not to consider the relaxed pulse as a manifestation of a normal pulse.
7. Identifying and Analyzing Long and Short Pulses
The identification of long and short pulses is very simple. According to the operational specifications of the “holding pulse light and heavy method”, if the cun pulse is excessively beyond the normal position at the cun and chi ends, it is a long pulse. If the cun and chi ends do not reach the normal position, it is a short pulse.
Generally, a long pulse is a manifestation of a strong constitution. Although a short pulse is not the expected pulse, it does not necessarily indicate a pathological pulse. If a short pulse is found in a short person without other discomfort, it may not be considered a pathological pulse.
It is generally believed that long pulses mostly indicate fullness, while short pulses mostly indicate deficiency. In fact, this is a general rule. For example, short pulses do not all indicate deficiency; in clinical practice, it is not uncommon for a pulse to be short due to Qi depression, Qi stagnation, Qi reversal, or Qi obstruction. Therefore, the identification and analysis of long and short pulses and their associated diseases should not be based solely on general rules and must not be formalized.
8. Identifying and Analyzing the Scattered Pulse
The scattered pulse has physiological and pathological types. The physiological scattered pulse is characterized by a “large” pulse body that objectively presents a “scattered” appearance, but the pulse body is rounded and there are no other discomforts. The pathological scattered pulse is characterized by a pulse body that is not rounded, excessively scattered, or overly broad, even to the point where the boundaries between the pulse vessel and surrounding tissues are unclear. The main difference between physiological and pathological scattered pulses is the degree of scattering. Therefore, the identification and analysis of the scattered pulse primarily depend on the degree of scattering.
In modern times, the application of the scattered pulse has decreased. The reason for this is that modern pulse texts have not understood the normative shape and practical significance of the scattered pulse. Therefore, the analysis of the scattered pulse and its associated diseases in modern pulse texts is indeed inappropriate.
In modern pulse texts, the scattered pulse is described as a “floating and scattered pulse without roots”. This is actually just one degree of the scattered pulse, which can only be seen in critical conditions. In fact, the scattered pulse is not necessarily characterized by “floating and scattered without roots” nor is it limited to critical conditions. It can be both a pathological pulse and a normal pulse, and sometimes it can even be a favorable sign of recovery. For example, the Suwen Pulse Essentials states: “If the heart pulse beats long, and the tongue cannot speak, if it is soft and scattered, it indicates recovery. If the lung pulse beats firm and long, and there is blood sputum, if it is soft and scattered, it indicates excessive sweating, leading to no further scattering. If the liver pulse beats firm and long, and the color is not blue, it indicates a drop in the pulse, as blood is under the ribs, causing shortness of breath. If it is soft and scattered, it indicates fluid retention, which is excessive thirst and easy to enter the skin, muscles, and intestines. If the stomach pulse beats firm and long, and the color is red, it indicates a fracture, and if it is soft and scattered, it indicates food stagnation. If the spleen pulse beats firm and long, and the color is yellow, it indicates shortness of breath, and if it is soft and scattered, it indicates foot swelling, as if it were water-like. If the kidney pulse beats firm and long, and the color is yellow and red, it indicates a fracture, and if it is soft and scattered, it indicates blood deficiency, which has not yet recovered.” The so-called soft and scattered refers to the pulse shape of the scattered pulse. Clearly, its associated diseases can vary in severity and can also represent a sign of recovery. The so-called “indicating recovery” means the disease is improving. This illustrates that the scattered pulse should not be considered a pulse pattern only seen in critical conditions.
9. Identifying and Analyzing the Hollow Pulse
The hollow pulse is a special pulse shape. It combines multiple conditions such as “floating, large, soft, central hollow, and both sides solid”, with the basic characteristics being “central hollow, soft, and both sides solid”. Its essence is a significant depletion of body fluids and blood, leading to insufficient blood volume in the pulse vessel, resulting in a pulse shape change that is inconsistent with the amount of blood loss. Therefore, in clinical practice, the occurrence of the hollow pulse is not high and is often a transient pulse pattern. If the hollow pulse appears in chronic diseases, it indicates extremely poor self-regulatory function.
The history of pulse diagnosis development shows that ancient physicians have consistently regarded “central hollow and both sides solid” as the basic characteristics of the hollow pulse, and there is generally no dispute. For example, if a person has lost blood and presents a hollow pulse, it indicates that the blood vessels are not coordinating with the amount of blood loss. If the amount of blood loss is excessive, the blood vessels should be “hollow”, and the blood vessels should contract accordingly. If the body has good blood loss regulatory function, the blood vessels should contract in accordance with the amount of blood loss. If there is a delay in the adaptive contraction of the blood vessels, it indicates that the blood loss regulatory function is poor. This is a method of analysis by ancient physicians regarding how pulse patterns reflect the functional state of the body. This analytical method is of great significance in clinical practice. In clinical practice, special attention should be paid to analyzing the functional state of the body based on changes in pulse patterns, which is one of the important roles of pulse diagnosis that must not be overlooked.
10. Identifying and Analyzing the Vacuous and Full Pulses
The vacuous and full pulses are based on the premise of a “large” pulse body. The practical significance of these two pulse patterns is to differentiate between vacuity and fullness based on a “large” pulse body. If the pulse body is not “large”, then the conditions for forming vacuous and full pulses are not met.
It is generally believed that a “large” pulse body indicates fullness, while a “thin” pulse body indicates vacuity. In fact, this is a general rule. A “large” pulse body does not always indicate fullness, and further differentiation and analysis are necessary. The vacuous and full pulses are specifically aimed at this situation. The identification method is: based on a “large” pulse body, if it is combined with conditions such as “slow, empty, soft”, it is a vacuous pulse, indicating vacuity. If it is “large and long” combined with a “slightly strong” manifestation, it is a full pulse, indicating fullness.
In clinical practice, the pulse body that can be diagnosed, apart from the normal pulse, falls into the categories of flooding and thin. “Flooding” represents a category larger than normal, while “thin” represents a category smaller than normal. Therefore, differentiating between vacuity and fullness based on a “large” pulse body is a very important aspect. Ancient physicians reformed the vacuous and full pulses and listed them as common pulse patterns, with the purpose being this. The history of pulse diagnosis development can illustrate this point.
Since the vacuous and full pulses are combined pulses, their nature is very clear. Therefore, the analysis of the nature of the diseases associated with the vacuous and full pulses is relatively simple; all vacuous pulses belong to vacuity, and all full pulses belong to fullness.
11. Identifying and Analyzing the Minute, Moist, and Weak Pulses
The minute (wei), moist (ru), and weak (ruo) pulses are based on the premise of a “fine and soft” pulse body. Among them, the minute pulse does not combine with other conditions. The moist pulse combines with “floating”. The weak pulse combines with “sinking”. These three pulse patterns have differences and should be distinguished. If the pulse body is not “fine and soft”, then the basic conditions for forming these three pulse patterns are not met.
Due to misunderstandings in modern pulse texts regarding the normative shape and practical significance of the minute pulse, it has been mistakenly believed that the minute pulse can only be seen in critical conditions. Therefore, this has affected the identification and analysis of the above three pulse patterns. In fact, from the perspective of normative shape and practical significance, the minute pulse has an allowable range of variation and can have different degrees. Therefore, the minute pulse is not exclusively a pulse pattern seen in critical conditions. The moist and weak pulses both contain the conditions for the minute pulse, namely, a “fine and soft” pulse body. On the basis of a “fine and soft” pulse body, if it combines with “floating”, it is a moist pulse; if it combines with “sinking”, it is a weak pulse. This indicates that none of these three pulse patterns are exclusively seen in critical conditions. Therefore, the analysis of these three pulse patterns and their associated diseases should be based on the actual degree of manifestation and should not be generalized. However, in general, these three pulse patterns reflect a relatively poor physical condition of the patient, indicating insufficient Qi and blood, and are mostly associated with vacuity or vacuity with some fullness.
12. Identifying and Analyzing the Moving Pulse
Identifying the moving pulse is generally done by matching the pulse shape recorded in ancient literature; if it matches, it is a moving pulse, and if it does not, it is not a moving pulse. This identification method is too mechanical and rigid. As a result, very few people have seen the moving pulse. The reason is that the normative shape and practical significance of the moving pulse have not been clarified.
Due to the difficulty in understanding the classic literature on pulse diagnosis, the practical significance of the moving pulse has been buried. Based on the records in the Treatise on Cold Damage and Miscellaneous Diseases and the Pulse Classic, the practical significance of the moving pulse can be further explored. It has been confirmed that the moving pulse is a pulse shape indicating a non-sinusoidal heart rhythm. Therefore, the identification of the moving pulse should be combined with the characteristics of the non-sinusoidal heart rhythm pulse shape, and it is not necessary to rigidly adhere to the ancient literature’s recorded pulse shape. The identification method can be flexibly mastered. For example, the Pulse Classic states: “The moving pulse is seen at the Guan position, without a head or tail, like a bean, and it moves and shakes.” The Pulse Classic also states: “If the left hand’s cun pulse is slightly moving, it is sometimes large and sometimes small, not uniform, from the cun to the Guan, and from the Guan to the Chi, the three positions vary and differ.” This indicates that ancient physicians did not identify the moving pulse using a single method. As long as it is clear that the moving pulse is a pulse shape indicating a non-sinusoidal heart rhythm, identifying the moving pulse is not difficult and is not uncommon in clinical practice.
In analyzing the diseases associated with the moving pulse, it is essential to consider the essence of the moving pulse. If one only analyzes based on the pulse shape, it often strays too far from the topic.
13. Identifying and Analyzing the Knotted Pulse
The identification method for the knotted pulse is very simple; any pulse that has “intermittence” is a knotted pulse. It should be noted that if the pulse is “rapid” but has intermittent occurrences, it is a hurried pulse. This is a pulse pattern that has differentiated from the “knotted pulse” and has its own diagnostic significance. Therefore, the knotted pulse and hurried pulse should be distinguished.
The knotted pulse primarily reflects arrhythmia, equivalent to modern medicine’s sinus arrest. The hurried pulse, in addition to reflecting arrhythmia, can also indicate a turning point in the cold-heat attributes of the disease, which has significant importance in differentiating “reversal” conditions of cold and heat. The analysis of the knotted and hurried pulses and their associated diseases must consider both arrhythmia and reflect the unique theoretical characteristics of traditional Chinese medicine. This is because traditional Chinese medicine has a unique understanding of the changes in pulse patterns associated with arrhythmia. For example, the hurried pulse appears on the basis of a rapid pulse, but traditional Chinese medicine believes that this is due to “Yang excess affecting Yin” or “extreme heat injuring Yin”. This is an understanding method guided by traditional Chinese medicine theory.
14. Identifying and Analyzing the Alternating Pulse
The alternating pulse reflects the alternation of the pulse, which plays an important role in identifying whether the changes in pulse patterns indicate disease and the development and outcome of the disease. However, modern pulse texts have misunderstood the practical significance of the alternating pulse, mistakenly defining it as a pulse pattern characterized by “the pulse comes and stops, with a fixed number, and after a long time, it comes again”, leading some pulse texts to stray too far from the identification and analysis of the alternating pulse and its associated diseases.
Based on the classic literature of pulse diagnosis, the practical significance of the alternating pulse can be further explored. It has been confirmed that the alternating pulse primarily reflects the alternation of the pulse, which is an important aspect of examining and analyzing pulse patterns. For example, according to the rules of pulse patterns changing with the “four seasons”, the pulse in spring should exhibit a tense appearance. If the pulse in spring is not tense, it indicates that the alternation of the pulse is abnormal, which is significant for analyzing whether the pulse pattern indicates disease. This method can be used to determine whether the pulse patterns throughout the year correspond with the “four seasons” and whether they indicate disease. Additionally, comprehensive analysis can be conducted based on the theory of the five elements’ mutual generation and mutual restraint to clarify the internal connections between pulse patterns and diseases. For instance, if a woman is three months pregnant, her pulse should exhibit a slippery appearance. If the pulse is not slippery but rather rough at three months of pregnancy, it indicates that the alternation of the pulse is abnormal, and the fetal essence is not being nourished. These examples illustrate that identifying and analyzing the alternation of the pulse has very important diagnostic significance. Therefore, the alternating pulse should not be considered a pulse pattern characterized by intermittence, as this contradicts the practical significance of the alternating pulse.
15. Identifying and Analyzing Changes and Transformations in Pulse Patterns
During the course of a disease, changes or transformations in pulse patterns occur, transitioning from one pulse pattern to another, which ancient physicians referred to as the “leather pulse”. The alternation of the pulse has certain rules, and the changes and transformations in pulse patterns during the course of a disease also follow certain rules. The alternating pulse and leather pulse are distinguished based on these two aspects of rules for identifying and analyzing pulse patterns. Ancient physicians diagnosed pulses by examining both the alternation of the pulse and whether the changes and transformations in pulse patterns during the disease process conform to the rules, which is very important for analyzing the pathological mechanisms. The more experience one has, the more significant the importance of these two pulse patterns becomes. However, due to the difficulty in understanding the expression methods of the Pulse Classic, the practical significance of these two pulse patterns has been buried.
Research indicates that modern pulse texts have buried the practical significance of the alternating and leather pulses, causing current pulse diagnosis methods to lose their original flexibility. Moreover, this has had a very negative impact on fully utilizing the diagnostic role of pulse diagnosis. Therefore, when comparing current pulse diagnosis methods with those recorded in classic literature, it is indeed inferior.
From the records in classic literature on pulse diagnosis, the methods developed by ancient physicians for pulse diagnosis are not only very practical but also flexible. However, since the Pulse Classic, pulse diagnosis has undergone changes, losing its original flexibility and dynamism. It has now been discovered that the main reason is the difficulty in understanding the expression methods of classic literature on pulse diagnosis, and some of the practical significance of pulse names has been buried, leading to the loss of the practical techniques of pulse diagnosis. Among them, the leather pulse and alternating pulse do not specifically refer to a certain type of pulse shape but represent two important methods for identifying and analyzing changes in pulse patterns. The alternating pulse is identified and analyzed according to the physiological changes in pulse patterns, while the leather pulse is identified and analyzed according to the pathological changes in pulse patterns. Therefore, the clinical application of these two pulse patterns is the most flexible and dynamic, and can be used to examine whether pulse patterns indicate disease, analyze the internal connections between pulse patterns and diseases, and diagnose the development and changes of diseases and their prognosis. For example, the Pulse Classic states: “The three-position pulse alternates; if it occurs in a long illness, it indicates death; if it occurs in an acute illness, it indicates life.” Undoubtedly, this specifically refers to the changes and transformations in pulse patterns during the course of a disease. It means that if an acute illness causes the pulse to change and transform, it indicates that the body’s adaptability or regulatory function is still intact, which is a manifestation of vitality, hence it is said that “acute illness indicates life”. If the pulse only changes and transforms after a long illness, it indicates that the body’s adaptability or regulatory function is poor, which is a manifestation of lack of vitality, hence it is said that “long illness indicates death”. For instance, if a patient has lost excessive blood, their pulse should be sinking and thin, which conforms to the development rules. If it does not transform into a sinking and thin pulse, it indicates that the blood loss regulatory function is too poor, which is a manifestation of lack of vitality. As Bian Que said: “If a patient vomits blood and has recurrent bleeding, their pulse should become sinking and thin; if it remains floating and large, it indicates death.” The so-called “large and firm” refers to the pulse not changing or transforming, rather than a combination of floating and firm pulses. The meaning of Bian Que is that in patients with recurrent bleeding, their pulse should change to sinking and thin; if the floating and large pulse does not change to a sinking and thin pulse, it indicates that the blood loss regulatory function is too poor, hence it indicates death. The so-called “floating and large” refers to the floating and large pulse not undergoing changes or transformations, which is not the same as the floating and large pulse being combined with the firm pulse. From the records in classic literature on the leather pulse and firm pulse, if the pulse changes or transforms according to the development rules of the disease, it is the leather pulse. If it does not undergo corresponding changes or transformations, it is the firm pulse. This illustrates that in clinical practice, examining the changes and transformations in pulse patterns according to the development rules of the disease is of great importance. Moreover, the development of diseases follows certain rules, and changes in pulse patterns must also follow certain rules. If the changes in pulse patterns do not conform to the development rules of the disease, further identification and analysis are required. This is very important for clinical syndrome differentiation and must not be overlooked.
In summary, each of the twenty-six common pulse patterns selected and established by ancient physicians has specific relevance, and their diagnostic significance is very important. However, due to the neglect or misunderstanding of the twenty-six pulse patterns, the methods for identifying pulse patterns have been affected, as well as the analysis of pulse patterns and their associated diseases. Therefore, it is essential to master the identification and analysis methods of each pulse pattern based on the normative shapes and practical significance of the twenty-six common pulse patterns, which is the foundation for identifying and analyzing complex pulse patterns.
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