1. Characteristics of Slippery Pulse
The pulse is smooth and flowing, like pearls rolling on a plate, indicating a sensation of fluidity. Ancients described this pulse as ‘li’, ‘zhuo’, ‘ying’, ‘zhang’, ‘lian zhu’, ‘ti ti ran’, and ‘xi yan chen’.
2. Principles of Slippery Pulse and Clinical Diagnostic Significance
1. Pathogenic Obstruction (Phlegm being the most common)
A slippery pulse indicates an excess of pathogenic factors. When pathogenic qi obstructs the flow of qi and blood, it results in a slippery pulse. This is akin to water flowing over stones in a river, where the water collides with the stones, creating ripples.
Many pathogenic factors can cause a slippery pulse, including phlegm, water retention, food stagnation, blood stasis, and qi stagnation. For instance, in the “Shang Han Lun”, it states: “If the pulse is slippery and rapid, it indicates food stagnation; it should be purged.” This indicates that food stagnation can lead to a slippery pulse. The “Jin Gui Yao Lue” states: “When the pulse is submerged and slippery, it indicates blood stasis in the uterus.” This indicates that blood stasis can lead to a slippery pulse. Li Zhongzi’s medical case states: “Xu Ling, the chief of the Ministry of Justice, suffered from excessive worry and anger, leading to profuse sweating, dizziness, confusion, and severe distress. Upon examination, the pulse was slippery and soft, indicating a significant deficiency of qi and phlegm rising. I prescribed Bu Zhong Yi Qi Decoction with Ban Xia (Pinellia) and Fu Zi (Aconite) for four doses, which slightly improved the condition. Then, I prescribed Liu Jun Zi Decoction with ginger juice and Xiang Fu (Cyperus) for two doses, and the illness was resolved. This was a case of phlegm causing a slippery pulse.
2. Heat Invading the Qi Level
Heat invading the qi level causes a rapid pulse. If the pulse beats quickly (rapid pulse) or does not significantly accelerate, it can lead to very rapid blood flow, which manifests as an unusually smooth pulse. However, this rapid blood flow does not necessarily mean a rapid pulse rate. The Yangming channel is rich in blood and qi, so once there is heat in the Yangming qi level, the influence of heat on the blood is evident, promoting smooth blood flow.
Examples of slippery pulses caused by heat invading the qi level are common in clinical practice and classical texts. For instance, in the “Shang Han Lun”, it states: “In cases of small chest syndrome, if there is pain upon palpation below the heart and the pulse is floating and slippery, Xiao Xian Xiong Decoction should be used.” It also states: “In cases of cold damage, if the pulse is slippery and there is a tendency to faint, Bai Hu Decoction should be used.” Additionally, it states: “In Yangming disease, if there is delirium and tidal fever, and the pulse is slippery and rapid, Xiao Cheng Qi Decoction should be used.” These are all examples of Yangming heat causing a slippery pulse.
3. Deficiency Leading to Slippery Pulse
In cases of deficiency, the pulse should not be slippery. When qi and blood are depleted, the pulse cannot be slippery. Therefore, Zhang Luyu stated: “A slippery pulse does not indicate weakness or cold deficiency.” However, when qi deficiency is severe and cannot contain the fluids, or when there is internal heat due to deficiency, the pulse can also be slippery. The “Pulse Theory Compilation” states: “However, in cases of deficiency, a slippery pulse may be observed, indicating the leakage of original qi.” The “True Inquiry into Pulse Theory” also states: “Sometimes, due to qi deficiency unable to control the yin fluids, a slippery pulse may be observed.” This slippery pulse should be weak upon palpation.
4. Normal Individuals with Slippery Pulse Indicate Abundant Qi and Blood
Healthy individuals may exhibit a slightly slippery pulse. A normal pulse is gentle (with a slight slippery quality), indicating a harmonious balance of ying and wei, and abundant qi and blood.
5. Pulse of Pregnant Women and During Menstruation
Pregnant women often have a slippery pulse, but it is not always the case; it is simply more common. The pulse of a pregnant woman is typically normal, gentle, and calm. A slippery pulse in pregnant women indicates the body’s need for blood to nourish the fetus.
6. Kidney Pulse is Deep, Soft, and Slippery
The kidneys store essence, and the essence of the five organs and six bowels originates from the kidneys. Essence and blood share the same source; when the kidney essence and blood are abundant, the pulse is slippery. Additionally, the kidney pulse is deep, indicating storage; slippery indicates yang, akin to fire bathing in water, thus the kidney pulse is deep, soft, and slippery, indicating balance.
Clinical Case 1
Zhao, female, 26 years old, first diagnosed on June 12, 2019.
Main symptoms: Recurrent dizziness for over a year, accompanied by vertigo.
Dizziness feels like being on a vehicle or boat, with a spinning sensation, severe cases lead to nausea and vomiting, sweating, reluctance to open eyes, chest tightness, excessive phlegm, bitter and dry mouth, normal bowel movements, slightly yellow and insufficient urination. The tongue is pale red with a thin white coating, and the pulse is slippery and large on the left guan, floating and slippery on the right guan.
Pulse analysis: The slippery pulse indicates phlegm, observed in both guan positions, indicating the disease is located in the liver and spleen channels. Poor spleen function leads to phlegm and dampness accumulation, with liver fire combining with phlegm invading the clear orifices.
Treatment method: Resolve phlegm and clear heat, drain liver fire.
Prescription: Modified Huang Lian Wen Dan Decoction.
Chen Pi (Tangerine Peel) 15g, Fu Ling (Poria) 15g, Ban Xia (Pinellia) 15g, Zhi Shi (Bitter Orange) 6g, Zhu Ru (Bamboo Shavings) 10g, Huang Lian (Coptis) 3g, Xia Ku Cao (Selfheal) 15g, Tian Ma (Gastrodia) 15g, Ze Xie (Alisma) 15g, Bai Zhu (White Atractylodes) 10g, Zhi Gan Cao (Honey-fried Licorice) 3g.
7 doses, decocted in water, 1 dose per day.
After taking the above formula for 3 doses, dizziness and bitter mouth improved. After completing 7 doses, all symptoms disappeared, and later, Liu Jun Zi Decoction was used for consolidation.
Clinical Case 2
He, male, 29 years old, first diagnosed on September 3, 2016.
Main symptoms: Patient has experienced dizziness and vomiting for six months, occurring daily, with varying severity; during severe episodes, there is a spinning sensation. He was diagnosed with Ménière’s disease at a hospital in Chongqing and underwent multiple hospital treatments with unsatisfactory results, having previously used Ling Gui Zhu Gan Decoction, Xiao Chai Hu Decoction, Er Chen Decoction, etc., with no significant effect.
Current diagnosis: Dizziness, morning nausea, dry heaving, numbness in limbs, stomach bloating with loss of appetite, fatigue, poor sleep, no dry mouth or bitter taste, normal bowel movements, tongue is enlarged with a thin white coating, and the pulse is deep, wiry, and slippery. Pulse analysis: The wiry pulse indicates liver and wind, while the slippery pulse indicates phlegm; combining the medical history, the four examinations suggest wind-phlegm disturbance.
Treatment method: Expel wind, transform phlegm, and pacify the liver.
Prescription: Ban Xia Bai Zhu Tian Ma Decoction combined with Ze Xie Decoction, modified.
Ban Xia (Pinellia) 15g, Chao Bai Zhu (Fried Atractylodes) 15g, Tian Ma (Gastrodia) 15g, Fu Ling (Poria) 15g, Chen Pi (Tangerine Peel) 15g, Ze Xie (Alisma) 18g, Zhi Gan Cao (Honey-fried Licorice) 6g, Zhi Tian Nan Xing (Prepared Arisaema) 15g (first decocted), Ji Xue Teng (Spatholobus) 24g, Fang Feng (Siler) 10g, Ge Gen (Kudzu) 12g.
5 doses, decocted in water, 1 dose per day.
After taking the above formula for 3 doses, dizziness significantly reduced, and appetite increased. The dosage of Ze Xie was reduced to 12g, and after taking another 7 doses, symptoms did not recur, and medication was stopped.
Conclusion
A slippery pulse is a manifestation of excess conditions, often indicating a solid pattern, with phlegm being the most common. In He’s case, it was a phlegm-damp condition, and previous treatments with warming and transforming phlegm formulas did not yield significant results, indicating it was not a cold-damp condition. Based on the sudden onset of symptoms and numbness in the limbs, it can be concluded that liver wind was the issue. The presence of a slippery pulse in this case played a decisive role in the differential diagnosis.
This article is excerpted from “Understanding and Practicing Pulse Diagnosis”, China Traditional Chinese Medicine Publishing House, He Benyang.