The Clinical Significance of the Slippery Pulse
The slippery pulse (hua mai) indicates yang. It can be felt by searching beneath the fingers. The three positions feel like beads moving; when pressed, they sink and do not advance or retreat. This is called slippery and is associated with the four limbs, causing weakness, soreness in the hands and feet, and red, painful urination.
The term “slippery” refers to yang water. What is yang water? It is water that contains fire. The slippery pulse is the opposite of the choppy pulse. When the nourishing qi is insufficient, the pulse becomes choppy and stagnant. When the nourishing qi is abundant, the pulse flows smoothly. Therefore, it is said that the nature of the slippery pulse is not solely yang or solely yin, but a harmonious combination of pure yang and proper yin. This is because the left kidney is associated with water, the right kidney with fire, the bladder with water, and the san jiao (triple burner) with fire. The balance of yin and yang and the interaction of water and fire allow the pulse to flow smoothly without the issues of stagnation. This is the normal pulse of a healthy person. The slippery pulse described here indicates that the fire within the water is excessive, boiling and bubbling. Thus, when searching beneath the fingers, the three positions feel like moving beads, as described by Liu, like water droplets on a lotus leaf, indicating smooth flow. When pressed, it sinks and does not advance or retreat, which means the pulse feels strong and does not yield easily to pressure. Therefore, the associated conditions include weakness in the limbs, which are governed by the spleen (earth). Weakness indicates that the fire is excessive and is affecting the spleen. Soreness in the hands and feet indicates that the excessive fire is damaging the kidney water. Red, painful urination indicates that the san jiao, associated with the excessive fire, is not functioning properly, leading to heat in the urine.
The pulse classic states that the slippery pulse flows smoothly, alternating and changing, resembling a number. One description states it is floating and feels strong; another describes it as slippery and wanting to escape. Danxi’s heart method states that a slippery pulse indicates abundant blood with phlegm. Zhang Zhongjing asked, “What does a slippery pulse mean?” The teacher replied, “A sinking pulse is pure yin, while a rising pulse is proper yang. The harmony of yin and yang results in a slippery pulse.”
Furthermore, the pulse classic states that a slippery pulse indicates abundant blood and insufficient qi, while a choppy pulse indicates insufficient blood and abundant qi.
Song:
The slippery pulse like beads is called yang. Vital energy in the waist penetrates the front intestines. Soreness in the shins is due to cold and heat. A great purge of the san jiao must be done for recovery.
The meaning here is that the nature of the slippery pulse, like moving beads, flows smoothly, indicating the presence of fire within water, hence it is called yang water. Therefore, the slippery pulse is like beads. Yang fire is the fire within water, which should be contained and not moved. However, it is not maintaining its proper position and is generating heat between the two kidneys, penetrating the front intestines, thus it is said that vital energy in the waist penetrates the front intestines. The soreness in the shins is due to the thin fire of the san jiao being unable to withstand the water. When water is weakened by fire, cold and heat arise. When cold and heat arise, water is harmed, leading to soreness in the shins. When the condition leads to soreness in the shins and cold and heat arise, there is no one who does not think of great tonics, yet they mistakenly think of great purges. They do not realize that treating illness must seek the root cause. For example, if a person has alternating cold and heat, with soreness in the shins and a pulse that is wiry, thin, and rapid, then tonifying true yin is appropriate. However, with a slippery pulse, it is different. The soreness in the shins is merely due to the boiling of cold and heat, which is caused by the bubbling of water and fire. Therefore, treatment must involve a great purge to suppress the fire of the san jiao, allowing the yang to retreat and the yin to flourish. If one only focuses on tonifying yin, it is like throwing a stone into water; how can one expect to achieve health? One should consider the theory of the “female pulse of the difficult classic” as being excessive and consult it mutually. The ancient texts state that the vital energy in the waist refers to the mingmen (gate of life), while penetrating the front intestines refers to the bladder channel. The mingmen and san jiao are situated in the front intestines, hence the urination is obstructed, and the bowel movements are dry and hard. With more heat and less cold, it is appropriate to purge with acrid and cold herbs. The Da Cheng Qi Decoction is indicated.
The pulse classic states that a slippery pulse indicates fullness and downward movement, and also indicates declining yang qi. It also states that a slippery and floating pulse disperses and is associated with wind. It further states that a slippery pulse indicates ghostly afflictions and that a slippery pulse with rapid beats indicates heat accumulation.
Another song:
The slippery pulse at the inch indicates much vomiting and reversal.
The slippery pulse indicates obstruction, often seen in the yang regions, and indicates stagnation in the upper jiao. This can lead to phlegm and fluid accumulation in the chest, hence the frequent vomiting and reversal symptoms.
The pulse classic states that a slippery pulse at the inch indicates fullness in the chest and reversal. It also states that a slippery pulse indicates yang excess, fullness in the chest, and vomiting. It is advisable to take Qian Hu Decoction and needle the Taiyang and Jueyin points to drain it.
At the guan pulse, a slippery pulse indicates cold in the stomach and inability to eat.
The guan position is where the spleen and stomach are assessed. When the spleen and stomach are warm, they can transform and digest food. If a slippery pulse is felt, it indicates that the spleen and stomach are deficient and cold, unable to properly digest food, leading to an inability to eat. Liu states that the slippery pulse at the guan position indicates that the liver is overcoming the spleen. This is not correct. I believe that the slippery pulse indicates that the water pulse is due to the spleen and stomach being deficient and cold, unable to control water, leading to slight evils affecting the spleen, hence the cold in the stomach and inability to eat. The slippery pulse at the chi position indicates cold in the navel area.
The pulse classic states that a slippery pulse at the guan position indicates fullness and reversal. It also states that a slippery pulse indicates heat in the stomach. A slippery pulse indicates real heat, with fullness of qi, hence the inability to eat. If food is ingested, it leads to vomiting. Therefore, it is advisable to take Zi Wan Decoction to drain it, or Da Ping Wei Wan to needle the stomach channel to drain it. I believe that the classic text states that a slippery pulse at the guan position indicates heat in the stomach, while the classic also states that a slippery pulse indicates cold in the stomach. This seems to contradict the classic text. However, the physician should also follow the symptoms. If the pulse is slippery and rapid, it is advisable to treat for heat; if it is slippery and slow, it is advisable to treat for cold. One should not adhere to a single theory. The classic also states that a slippery pulse at the guan position that is uneven in size indicates that the condition is wanting to progress but cannot. If the person desires to drink a lot, drinking leads to diarrhea; if it stops, it leads to death.
At the chi position, it feels like ice at the navel. Drinking water leads to a dripping sound from the lower jiao.
Yunqi Zi states that the left chi pulse indicates sinking water, while the guest pulse is slippery water. The two waters combine, leading to cold accumulation in the bladder, hence the navel feels like ice, gathering below and not rising to support the fire, hence the desire to drink water. Water stagnates in the lower jiao and cannot be drawn into the organs, hence the dripping sound.
The pulse classic states that a slippery pulse at the chi position indicates slight diarrhea and insufficient qi. It also states that a slippery pulse indicates abundant blood. If a woman has menstrual irregularities, or a man has blood in the urine, it is advisable to take a decoction of purgative salt or Da Huang Decoction to expel the menstrual blood and needle the Guan Yuan point to drain it. It also states that a slippery pulse that is deep and slippery indicates…