Traditional Chinese Medicine Case Studies / Medical Discussions / Reference Articles for Clinical Study of TCM
Introduction: Today we introduce the “String Pulse”.
The string pulse has two main characteristics: first, it is tense and stable, with a significant tension, referred to as “straight as a string”.
1Generally speaking, it represents a pulse associated with pathogenic factors. Therefore, the “Jing Yue Quan Shu – Chapter on Pulse Spirits” states: “It is due to disharmony of blood and qi, qi counterflow, excess of pathogenic factors, strong liver and weak spleen, cold and heat, phlegm and fluid, retained food, accumulation, distension, deficiency labor, pain, and rigidity…”. Clinically, this is indeed the case; various conditions such as wind-cold invasion, phlegm and blood accumulation, emotional stagnation, liver yang hyperactivity, and pervasive yin pathogens can all present with varying degrees of string pulse. This is primarily due to the disharmony of yin and yang, which mutually reject each other. Therefore, the string pulse is often seen in excess conditions, hence “Zhen Zong San Mei” states: “The string pulse is the foremost indicator of the six residual evils, most commonly seen in diseases of the channels, hence it is prevalent in cold damage syndromes.” As a result, many medical texts later referred to the string pulse as the “forbidden pulse of a hundred diseases”, and Zhang Jingyue also stated, “If this pulse is present in various diseases, it is certainly not auspicious.” 2However, can we summarize the string pulse in this way? Not necessarily; for example, the “Jin Kui – Chapter on Vomiting and Diarrhea” states: “A string pulse indicates deficiency; the stomach qi is insufficient, resulting in morning food being vomited in the evening, turning into stomach reversal; cold is present above, and if treated below, the pulse becomes string, hence it is called deficiency.”Morning food being vomited in the evening indicates a severe deficiency of spleen and kidney yang. The so-called “cold present above” refers to deficiency cold, not an actual cold pathogen. Therefore, You Zaiqing’s “Jin Kui Heart Classic” also explains: “The string pulse is not due to external cold added to the string, but rather a string pulse arising from stomach deficiency leading to cold; with stomach deficiency and cold, and insufficient yang qi, morning food is vomited in the evening, resulting in stomach reversal. From this, we understand that the string pulse can indicate deficiency, referred to as cold, which is a shallow understanding of pulse diagnosis.” You Zaiqing’s opinion is worth our reference in clinical practice.3The string pulse not only has both excess and deficiency, but it is not always a pathological pulse; it can also represent the aspect of Zheng Qi. The “Shang Han Lun – Yangming Chapter” states: “If a person with cold damage vomits or has diarrhea, and does not resolve, and does not have a bowel movement for five to six days, up to ten days, with tidal fever in the afternoon, not fearing cold, and speaking as if seeing ghosts. If severe, they do not recognize people when fever occurs, feel anxious and restless, slightly wheezing and staring, if the pulse is string, they live; if it is rough, they die.” After cold damage, if there is vomiting or diarrhea, it indicates a severe injury to the fluids; if the fluids are severely injured and the pulse is string and rough, how can there be a distinction between life and death? Wang Hu’s “Shang Han Lun Differentiation and Annotation” explains: “Both string and rough are yin pulses; a string pulse indicates that yin is not yet exhausted, still carrying nourishment, hence it can live; a rough pulse indicates that yin is exhausted, already depleted, hence it is said to die.” Wang Hu’s explanation is based on Cheng Wujis’ “Annotations on Shang Han Lun” and is quite reasonable. At the same time, Yu Jiayan, in explaining the clause “If the pulse is string after diarrhea, with fever and sweating, it indicates self-recovery,” also states: “This means that the prolonged pathogenic factor has deeply penetrated the yin aspect; the pulse should be deep, weak, fine, or rough, but suddenly turning to string indicates the emergence of the lesser yang’s vitality, indicating recovery.” It can be seen that the string pulse indeed can appear as a representation of Zheng Qi.This Zheng Qi symbolizes the “emergence of vitality”. Any string pulse that represents vitality generally arises from the following mechanisms: Initially, the pulse may be floating and weak, empty and rootless; as the kidney qi returns to the source, the pulse body becomes quite thick, and at this time, the pulse presents a string appearance. Initially, the pulse may be deep and weak, listless; as the liver and spleen qi become vigorous, the pulse becomes quite strong, and the pulse appearance shows string. Initially, the pulse may be very scattered, unclear; as the yang returns and qi gathers, the pulse shape becomes quite firm, and the pulse appearance shows string. Initially, the pulse may be thin and rapid, lacking spirit; as the yang returns and qi fills, the pulse becomes quite smooth and even, and this pulse has a string appearance.All of the above string pulses are transitions from emptiness to fullness, from weakness to vigor, from dispersion to gathering, from obscurity to clarity, thus their essence represents the trend of evil retreating and Zheng Qi recovering. However, it is still in the stage of “initial recovery of yin and yang”; Zheng Qi can only fill the meridians, making the pulse shape become tense and strong, but it has not yet reached the state where Zheng Qi overflows outside the meridians, making the pulse become smooth, warm, and abundant, which is the pulse of rich stomach qi, hence it is still referred to as string.4Wang, a middle school teacher, had a long-term low fever with no clear cause after numerous examinations; he was eventually cured using methods to warm yang and tonify qi. During the illness, his pulse was always fine; after taking Dang Gui Bu Xue Tang with Fu Zi, Bai Wei for over forty doses, and Bu Zhong Yi Qi Tang with Aupian for over twenty doses, the stubborn low fever was finally subdued, and the pulse also became strong. He had a relative knowledgeable in medicine who said his pulse was string, that the disease had retreated but the pulse had not, which was indeed alarming. Upon further examination, it was confirmed that the pulse was rising and falling evenly, quite firm, and calling it a string pulse was indeed correct. I told him this was a manifestation of the gradual internal filling of yang qi.This was in 1972, and this person is still teaching in middle school, in good health and successful in work; although the experience is not extensive, this was indeed a practical verification.I have also realized that in long-term illness, a pulse that is string and strong often reflects the internal encounter of true qi, especially in the chi pulse. In more severe conditions, the cun and guan pulses may be knotted or sunken, while the chi pulse is full and string, rising and falling strongly, often symbolizing that the foundation has not been shaken, because true qi cannot reach above, it must accumulate below. Of course, there is a saying that in long-term illness, the chi pulse should avoid string, but this only refers to avoiding a “hard and isolated” string, not avoiding a “long and full” string. A hard and isolated string lacks stomach qi, hence it should be avoided; a long and full string has stomach qi, hence it should not be avoided. The “Su Wen – Discussion on the Qi of the Balanced Person” states: “In spring, a slightly string pulse indicates balance; a string pulse with more stomach qi and less indicates liver disease, but a string pulse without stomach qi indicates death.” These statements are very important for diagnosing string pulses; the string pulse has both a pathological aspect and a Zheng Qi aspect; how to accurately distinguish them requires analyzing the situation of the disease, and from the pulse body itself, whether there is stomach qi, how much stomach qi there is, is crucial.Note: This article is excerpted from “Selected Lectures on TCM – Volume 1”, compiled by the Graduate Class of the TCM Research Institute, published by the People’s Health Publishing House, October 1980.You May Also Like, click to read the original text:Ren Yingqiu: Summary of Experience in Treating Various PainsRen Yingqiu: Floating Pulse Does Not Necessarily Indicate Exterior, and the Ru Pulse Is Not to Be Understood as “Confucian”//////////[ Read Previous Highlights ]#TCM Introduction Collection #Twelve Meridians Explained in Simple Terms #Donghai Medical Collection #Experiences of Old TCM Practitioners #Wonderful TCM Formulas #Secret Formulas and Recipes #Masters of Traditional Chinese Medicine#Famous Cases from Shang Han Lun #Selected Famous Cases from Jin Kui#Si Jun Zi Tang #Etiology Assignment #Herbal Properties Assignment #Herbal Properties Song for 400 Herbs #Medical Three-Character Classic #Daily Insights from Mentorship in Medicine#Daily Insights from Mentorship in Theory, Methods, Formulas, and Medicines#TCM Serialized CollectionWhat is the Essence of Using Warming Meridian Decoction?Zhou Zhongying: Insights and Techniques from 60 Years of TCM Diagnosis (All Essentials)Ding Guangdi: Qiang Huo Sheng Shi Decoction for Treating “Five-Phase Diarrhea”Unexpectedly, “Qing Gu San” Really Treats Fever After Bone Fractures!Dan Zha San for Treating Hyperlipidemia (Including Four Recipes for Hyperlipidemia)Shanghai Shen’s Gynecology 600-Year Family Secret RecipeMiraculous! 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