Slippery Pulse (Hua Mai)
(1) Pulse Characteristics
The characteristic of a slippery pulse is that it flows smoothly, like pearls rolling, moving forward and then retreating. The “Pulse Classic” states: “Moving forward and retreating, flowing smoothly and turning, resembling the number of times.”
(2) Similar Pulses
Both slippery and rapid pulses flow smoothly. The main feature of a slippery pulse is its forward and retreating motion. Forward means to advance, while retreating means to go back. It rolls like pearls. The main feature of a rapid pulse is its urgency, without the rolling sensation.
(3) Pulse Theory and Main Diseases
1. Normal Pulse
(1) In healthy individuals, a slippery pulse indicates abundant Qi and blood.
(2) The kidney’s normal pulse is deep and soft-slippery. The kidney stores essence, and the essence of the five organs and six bowels gathers in the kidney. Qi and blood share the same source; thus, when the kidney’s essence and blood are abundant, the pulse is slippery. Additionally, the kidney pulse is deep, indicating storage; slippery represents Yang, like fire hidden in water, hence the kidney pulse is deep and soft-slippery when normal.
(3) Pregnant women gather blood to nourish the fetus, hence the blood is abundant and slippery.
2. Pathological Pulse
(1) Pathogenic Obstruction: A slippery pulse indicates an excess of pathogenic factors. When pathogenic Qi obstructs, Qi and blood want to flow but clash with the pathogen, causing the pulse to be slippery. It is like water flowing over stones, creating waves. Therefore, the “Golden Chamber” states: “Slippery indicates fullness.”
Pathogenic factors that can lead to a slippery pulse are numerous, including excess heat, water retention, blood stasis, Qi stagnation, phlegm-dampness, and food accumulation. For example, the “Treatise on Cold Damage” states: “If the pulse is slippery and there is a cold extremity, there is heat inside; Bai Hu Decoction is indicated.” This indicates that excess heat causes slipperiness. The “Treatise on Cold Damage” also states: “If the pulse is slippery and rapid, there is food accumulation.” This indicates that food accumulation causes slipperiness. The “Golden Chamber” states: “When the deep and slippery pulse clashes, there is blood stasis in the womb.” This indicates that blood stasis causes slipperiness. The “Golden Chamber” also states: “Slippery indicates Qi.” This indicates Qi stagnation and slipperiness. The “Treatise on Cold Damage” states: “If there is a small chest knot, pressing under the heart causes pain, and the pulse is floating and slippery, Xiao Xian Xiong Decoction is indicated.” This indicates that phlegm-heat causes slipperiness. All of the above are due to pathogenic fullness leading to a slippery pulse.
One may ask, since it is a pathogenic obstruction, why is the pulse not deep, slow, thin, choppy, or knotted but rather slippery? The reason is that when the obstruction is severe, the Qi mechanism is also heavily obstructed, making it difficult for Qi and blood to flow, hence the pulse may appear deep, slow, thin, choppy, or knotted, or even closed and retracted. If the obstruction is not severe, Qi and blood can clash with the pathogen, causing waves to rise, thus the pulse can be slippery. This slipperiness must be strong upon palpation.
(2) True Deficiency with Slippery Pulse: In cases of true deficiency, the pulse should not be slippery. When Qi and blood are depleted, the pulse cannot be slippery. Therefore, Zhang Luyu said: “A slippery pulse does not show weakness; there is no principle of deficiency and cold.” However, when the righteous Qi is significantly deficient and cannot be contained internally while leaking externally; or when the righteous Qi is deficient and the fire is internally blazing, the pulse can also be slippery. As stated in the “Pulse Study Compilation”: “However, in cases of deficiency, there are instances of a slippery pulse, indicating the leakage of original Qi.” The “Pulse Theory Seeking Truth” also states: “Sometimes due to Qi deficiency, it cannot control Yin fire, resulting in a slippery pulse.” This slipperiness must be weak upon palpation. Clinically, a slippery pulse due to true deficiency is often seen in cases of spleen deficiency leading to phlegm, which is also slippery but weak, or slow and slippery without strong pressure.
If the pulse is slippery, firm, and rebounds under pressure, lacking a gentle and relaxed quality, it resembles the true heart pulse, “firm and rebounding, like rolling Job’s tears, densely packed.” This is a true organ pulse, indicating great deficiency, and should not be mistaken for a full pulse.
Choppy Pulse (Se Mai)
(1) Pulse Characteristics
The characteristics of a choppy pulse are more difficult to grasp. Throughout history, many qualifiers have been added, and numerous metaphors have been listed. The intention to clarify the choppy pulse has instead led to many redundant words, making it difficult to recognize.
The original meaning of a choppy pulse is that it flows with difficulty, just as Wang Bing noted in the “Plain Questions: Pulse Essentials”: “Choppy means that the flow is not smooth and is obstructed.” Wang Shuhe modified it to: “Choppy pulse is thin and slow, difficult to flow and scattered, or stops and then comes back,” proposing five conditions for a choppy pulse: thin, slow, stop, scatter, and difficult to flow. Later generations often follow this view, such as in the “Pulse Classification Compilation” which states: “Slow, thin, and short, all three characteristics must be present.” In other words, a choppy pulse must possess the three conditions of being slow, thin, and short; missing any one of these is unacceptable. Li Pinghu stated: “If the balance of the three and five is not adjusted, it is called choppy.” On the three conditions of thin, slow, and short, he added the condition of unevenness in number. He also stated: “Scattered and stopping are faintly felt between the fingers, like rain touching sand, easily dispersing.” In summary, the conditions for a choppy pulse are thin, slow, short, stop, scatter, weak, and difficult to flow, seven elements in total. However, the “Plain Questions: Regulation of the Menstrual Cycle” states: “If the pulse is large and strong, it is choppy.” From the meaning of this sentence, it is clear that this choppy does not refer to the superficial pulse but rather to the pulse characteristics. A choppy pulse can be seen alongside a large pulse; since it is large, it cannot be thin and short, indicating that at least three of the conditions must be absent. Thus, it is evident that short and thin are not essential conditions for a choppy pulse. The “Spiritual Pivot” states: “If the pulse is large and firm, it is choppy;” the “Nanjing” states: “In cases of cold damage, the pulse is both Yin and Yang abundant and tight and choppy.” A choppy pulse should be thin, slow, short, and weak, while a large, tight, firm pulse is strong and cannot coexist with a choppy pulse. The “Treatise on Cold Damage” states: “If the inch pulse is floating and rapid, while the deep pulse is choppy.” A choppy pulse should be short; how can it coexist with a long pulse? The thin, slow, short, scatter, weak characteristics of a choppy pulse cannot coexist with the rapid, long, large, firm, and tight characteristics. Thus, a choppy pulse is not necessarily thin, scattered, or weak.
Later physicians proposed: “If the balance of the three and five is not adjusted, it is called choppy.” The term “three and five” is often interpreted by physicians as unevenness in the three and five, which includes stopping. The normal pulse of the lung is often floating, short, and choppy; if there is stopping and unevenness in the three and five, the pulse rhythm is disordered, which cannot be a normal pulse, how can it be called a normal pulse? Furthermore, a choppy pulse can also be divided into inch choppy, guan choppy, and chi choppy; the pulse is one Qi flowing through, how can the inch pulse be uneven while the guan and chi pulse rhythms are orderly? Therefore, a choppy pulse should not have stopping.
The term “three and five” appears in the “Inner Canon” in two instances: “Plain Questions: Discussion on the Three Parts and Nine Pulses”: “When the form and Qi are in harmony, they live; when the balance of the three and five is not adjusted, they die.” “Plain Questions: Discussion on the Eight Vital Spirits”: “With the cold and warmth of the sun, the fullness and emptiness of the moon, and the floating and sinking of the four seasons, the three and five must be harmonized and adjusted.” The term “three and five” in the “Inner Canon” refers to the idea of comparing and analyzing to seek understanding. Wang Bing’s commentary states: “To compare is to compare; to group is to classify. If the comparison and classification are not adjusted, it means that they do not follow their usual patterns, which indicates illness.”
According to the two instances of the term “three and five” in the “Inner Canon,” it means comparing and analyzing to understand. “Three and five not adjusted” refers to the analysis and comparison to know the harmony between a person’s form and Qi, and the person and the seasonal changes; this indicates illness. To interpret “three and five” as a literal translation of “three and five” is incorrect; moreover, the original text of the “Inner Canon” does not imply the meaning of three and five not being adjusted, nor does it derive the meaning of stopping, which is a further error. The phrase “three and five not adjusted” has never referred to a choppy pulse in the “Inner Canon.” As for the individual who first coined the phrase “If the balance of the three and five is not adjusted, it is called choppy,” there is no evidence, and later generations have carelessly repeated the erroneous idea of a choppy pulse being “three and five not adjusted, with stopping,” leading to widespread misunderstanding to this day.
In summary, a choppy pulse should not have the conditions of being slow, thin, short, scattered, weak, or stopping; only the characteristic of “difficult to flow” remains.
“Difficult to flow” means that the pulse’s rise and fall are both difficult; this is similar to the slow pulse’s slow movement, indicating that slow and choppy pulses are indistinguishable and represent the same pulse quality. Therefore, “difficult to flow” does not refer to the pulse’s rise and fall being difficult and slow; rather, it refers to the small amplitude of the pulse due to Qi and blood stagnation, or Qi and blood deficiency, which cannot flow smoothly, resulting in this pulse quality. In clinical practice, I use the small amplitude of the pulse as the sole characteristic to judge a choppy pulse. Regardless of the pulse’s size, length, strength, or rhythm, as long as the pulse’s rise and fall have a small amplitude, it is a choppy pulse. This is also the meaning of “difficult to flow.”
(2) Pulse Theory and Main Diseases
A choppy pulse with a small amplitude is due to Qi and blood not being able to surge effectively. The reasons for Qi and blood not surging effectively are either Qi and blood deficiency leading to weak surging; or Qi and blood being obstructed by pathogens, preventing smooth flow and causing the pulse to have a small amplitude and become choppy.
1. Qi and blood deficiency leading to choppy pulse Blood deficiency can cause a choppy pulse, hence a choppy pulse indicates essence depletion and blood deficiency. This is a consensus among physicians. Qi and blood share the same source; when blood is deficient, it cannot fill the blood vessels, leading to a choppy pulse. Due to blood deficiency, symptoms such as heart pain, palpitations, amenorrhea, and difficult labor may occur.
Regarding the choppy pulse indicating Qi deficiency, many physicians disagree. The “Inner Canon” states: “Choppy indicates excess Yang Qi.” Throughout history, many physicians have followed this view, believing that choppy indicates excess Qi. For example, the “Pulse Classic” states: “A choppy pulse indicates less blood and more Qi.” The “Thousand Gold Prescriptions” states: “A choppy pulse indicates less blood and more Qi.” The “Essentials of Diagnosis” states: “Choppy indicates more Qi and less blood.” If blood is less and Qi is more, then the surging should be strong, and the pulse should show floating, hollow, firm, or weak characteristics, rather than a choppy pulse, which seems to contradict the original text of the “Inner Canon.” In fact, the “Inner Canon” refers to excess Yang Qi, indicating Qi stagnation. As the “Essentials of Surgery” states: “A choppy pulse indicates Qi stagnation.” The “Pulse Study Compilation” states: “There are also seven emotions causing stagnation, and Qi stagnation, blood stasis, cold excess, heat pathogens, and food accumulation can all lead to a choppy pulse.” Regarding the choppy pulse indicating Qi deficiency, only a few physicians have mentioned it. For example, the “Complete Book of Jing Yue” states: “Choppy indicates Yin pulse, indicating both Qi and blood deficiency.” The “Pulse Theory Seeking Truth” states: “Choppy indicates both Qi and blood deficiency.” Thus, it can be seen that Qi and blood deficiency, lacking the strength to surge in the pulse, leads to a small amplitude and forms a choppy pulse. In cases of deficiency leading to a choppy pulse, it must be weak upon palpation.
2. Pathogenic obstruction leading to choppy pulse Pathogenic obstruction leads to Qi mechanism stagnation, preventing Qi and blood from flowing smoothly and causing a small amplitude and a choppy pulse. The main pathogenic factors causing obstruction include external pathogens, Qi stagnation, blood stasis, cold excess, heat pathogens, and food accumulation. For example, the “Treatise on Cold Damage” states: “How do we know that sweating does not penetrate? It is known by the choppy pulse. This choppy indicates that the exterior pathogen obstructs and prevents the Ying and Wei from flowing smoothly, causing the Yang Qi to be obstructed and unable to rise, resulting in a choppy pulse.” The “Pulse Theory Seeking Truth” states: “However, it is also necessary to differentiate between cold choppy, dry choppy, and heat choppy.” This indicates that a choppy pulse can be caused by cold invasion, Yang deficiency, Yin blood depletion, or heat pathogens obstructing the flow. The “Pulse Study Compilation” states: “Food phlegm solidifies inside and outside… seven emotions causing stagnation, and Qi stagnation can all lead to a choppy pulse.”
True deficiency choppy pulse is weak, while obstructive choppy pulse is strong. Just as the “Pulse Study Compilation” states: “A choppy pulse should be distinguished by the presence or absence of pulse strength to determine its deficiency or excess.”
Empty Pulse (Xu Mai)
(1) Pulse Characteristics
The “Pulse Classic” states: “An empty pulse is slow, large, and soft, insufficient upon palpation, and feels empty under the fingers.” This indicates that an empty pulse consists of four elements: floating, slow, large, and empty. Many later physicians have followed this view.
Ancient descriptions of an empty pulse only included one element: lack of strength upon palpation, without implying floating, slow, or large. The “Plain Questions: Demonstrating Calmness” states: “If the pulse is floating, large, and empty, it is due to the spleen Qi being completely exhausted.” The “Plain Questions: Treating Malaria” states: “In malaria, the pulse is large and empty.” The “Plain Questions: The Generation of the Five Organs” states: “The yellow pulse is the most extreme, large and empty.” The “Inner Canon” considers floating, large, and slow as accompanying pulses of an empty pulse, indicating that an empty pulse itself does not necessarily possess the characteristics of floating, large, or slow. Furthermore, the “Golden Chamber” states: “In healthy men, a large pulse indicates labor, and an extremely empty pulse also indicates labor.” This indicates that emptiness is not necessarily large. The “Golden Chamber” also states: “An extremely empty pulse is hollow and slow.” This indicates that slow is not a characteristic of an empty pulse. Therefore, the main characteristic of an empty pulse is lack of strength upon palpation; whether it is floating, slow, or large is not an inherent characteristic of an empty pulse.
(2) Similar Pulses
The main characteristic of an empty pulse is lack of strength upon palpation. Similar pulse qualities include floating, hollow, firm, scattered, weak, soft, and slippery, which must be distinguished.
1. Empty vs. Floating: A floating pulse is easily felt with light pressure, but lacks strength upon palpation. Its lack of strength is only in comparison to the floating pulse, not indicating a lack of strength overall. An empty pulse is characterized by lack of strength upon palpation.
2. Empty vs. Hollow: A hollow pulse is floating and large, with a hollow feeling on both sides. An empty pulse, while lacking strength upon palpation, does not yet feel hollow.
3. Empty vs. Firm: A firm pulse feels like pressing on a drum skin; when felt floating, it is large and strong, like a taut drum skin, but upon palpation, it feels empty. An empty pulse lacks strength upon palpation, unlike a firm pulse, which feels less strong but has not yet reached the hollow feeling.
4. Empty vs. Scattered: A scattered pulse is floating, large, and extremely weak, with a vague boundary, like willow fluff floating lightly, its trace uncertain. An empty pulse, while floating and weak, still has a clear boundary, and its degree of weakness is not as severe as a scattered pulse.
5. Empty vs. Weak: A weak pulse is deep and weak, not found in the floating position, and its thinness and weakness are more pronounced than an empty pulse.
6. Empty vs. Soft: Most pulse texts describe a soft pulse as floating and fine. I believe a soft pulse is simply a weak pulse, not necessarily floating and fine. Its softness also indicates insufficient pulse strength, but it is not as weak as an empty pulse. If it is floating and soft, it is similar to a weak pulse, with only slight differences in thinness and weakness, making it clinically difficult to distinguish; they can be regarded as the same pulse quality.
(3) Pulse Theory and Main Diseases
An empty pulse is a very important pulse, as the pulse is based on the principles of deficiency and excess; if the pulse is empty, the righteous Qi is deficient.
An empty pulse indicates deficiency of righteous Qi. Any deficiency of Yin, Yang, Qi, or blood can lead to an empty pulse. When Yang Qi is deficient, the blood vessels cannot surge effectively, resulting in an empty pulse. When Yin blood is deficient, it cannot be contained internally, causing Yang Qi to float; when Yin blood cannot fill the blood vessels, the pulse cannot withstand heavy pressure, leading to an empty pulse. Clinically, whenever an empty pulse is observed, it undoubtedly indicates deficiency of righteous Qi; whether it is Yang deficiency, Qi deficiency, or Yin deficiency, or blood deficiency, must be determined by combining accompanying pulses and the patient’s spirit, complexion, tongue, and symptoms.
Full Pulse (Shi Mai)
(1) Pulse Characteristics
A typical full pulse is large and long, both floating and deep, with a strong beat. However, some full pulses are not very typical. Sometimes, the floating pulse may not be prominent, while the deep pulse is large and strong, or the pulse may be large and strong but not long; or both floating and deep pulses may be strong but not very large. All of these can be classified as full pulses. Therefore, the main characteristics of a full pulse are being large and strong; whether it is floating and long is not a primary characteristic.
(2) Similar Pulses
The main characteristic of a full pulse is being large and strong. Similar pulses include deep, firm, and surging pulses.
1. Full vs. Deep: A deep pulse is insufficiently felt when lifted, but strong when pressed, being firm on the inside and soft on the outside, unlike a full pulse, which is large and strong in all three positions; even if the deep pulse is strong, it is not as large and strong as a full pulse.
2. Full vs. Firm: A firm pulse is located deep and is large and taut, not seen in the floating position. A firm pulse can also be called a deep full pulse.
3. Full vs. Surging: A surging pulse rises and falls, like waves surging, although it is large and floating, it slightly decreases upon palpation, unlike a full pulse, which is large and strong upon palpation.
4. Full vs. Long: A long pulse extends beyond its normal position, flowing smoothly like a long pole, unlike a full pulse, which is large and strong. If a long pulse is excessive, large and firm, it is also a full pulse.
(3) Pulse Theory and Main Diseases
1. Pathogenic Fullness A full pulse indicates a full syndrome. When pathogenic Qi is excessive, the righteous Qi fights against the pathogen, surging Qi and blood, hence a full pulse is observed.
(1) External Pathogenic Factors: When external pathogenic factors invade, the pathogenic Qi is excessive, and the righteous Qi clashes with the pathogen, the pulse can be full. If the six excesses transform into fire, and the three burners are hot, clashing with Qi and blood, surging the blood vessels, the pulse is full. Treatment should focus on clearing heat and draining fire, or unblocking the bowels to expel heat, or inducing sweating to expel pathogens, all following the principle of “for fullness, drain it” to expel the pathogen.
(2) Internal Injury: In cases of internal injury, a full pulse can often be observed, and this full pulse is more complex. If the pulse is full, the tongue is red with a yellow coating, and there are clear heat signs, it indicates a syndrome of excessive heat, and treatment should focus on clearing heat and draining fire. If the pulse is full but the tongue is not red and the coating is not yellow, and there are no heat signs, it may be due to phlegm turbidity, blood stasis, or food accumulation, where pathogenic Qi obstructs the interior, causing Qi mechanism disturbance, and the righteous Qi struggles against the pathogen, leading to a full pulse. It can also be seen in cases of liver Qi stagnation, where Qi stagnation leads to blood stagnation, causing Qi and blood to surge, resulting in a full pulse.
2. True Deficiency In some special cases, a full pulse can indicate a deficiency syndrome. For example, in cases of gastric Qi exhaustion, the true Qi leaks out, and the pulse appears strong and forceful, losing its harmonious quality, which can be seen as a full pulse. As stated in the “Treatise on Cold Damage”: “In cases of cold damage, if there are more than ten bowel movements in a day, and the pulse is full, it indicates death.” In this case, the full pulse does not indicate a full syndrome but rather gastric Qi exhaustion, and one must not mistakenly treat it aggressively.
When the counterflow Qi rises, the pulse can be full. Zhang Xichun believes: “The eight pulses are based on the counterflow pulse.” “It is connected to the stomach’s Yangming channel and linked to the kidney’s Shaoyin channel.” When the stomach is deficient and cannot hold, or the kidney is deficient and cannot contain, the counterflow Qi rises, drying out the Qi and blood, leading to a full pulse. Zhang states: “The pulse is taut and large, pressing it feels strong, but it is not truly strong; this is the leakage of the spleen and stomach’s true Qi, with counterflow Qi rising.” Treatment should focus on nourishing the source and calming the counterflow.