Introduction: Zhang Zhongjing’s pulse diagnosis is not merely a theoretical overview, but is closely integrated with clinical practice.
Today, we present an analysis of Zhang Zhongjing’s Xian pulse by Mr. Gu Juezhong from Ningxia Medical University. Mr. Gu’s reasoning is clear and his arguments are sound, providing us with a correct method for interpreting Zhang Zhongjing’s pulse diagnosis.
Zhang Zhongjing’s pulse diagnosis, as he stated in his preface, is theoretically based on the “Nine Volumes of Suwen”. However, it differs from the pure theoretical overview of the “Suwen” as it combines his clinical practice experience, organically integrating the changes in pulse patterns within the context of syndrome differentiation, further developing and validating them through repeated clinical diagnosis.
His works, “Shang Han Lun” and “Jin Kui Yao Lue” (hereinafter referred to as “Jin Kui”), title each disease with “Disease, Pulse, Syndrome, and Treatment”, closely linking diagnosis and treatment, thus becoming a model for future generations.
However, many later pulse studies have made the pulse phenomena overly mysterious and speculative, leading people into confusion, which is undesirable.
The author believes that to learn and study Zhang Zhongjing’s pulse diagnosis, one must deeply understand the content of its classical texts, distilling the essence from the coarse, discarding the false and retaining the true, and adopting the scientific viewpoints and methods of syndrome differentiation and treatment, which is the correct scientific attitude.
This article aims to roughly explore the relationship between the Xian pulse and pain syndromes, to clarify this for fellow practitioners.
1
Analysis of Xian Pulse and Pain Syndromes in “Shang Han Lun” and “Jin Kui”
In Zhang Zhongjing’s “Shang Han Lun” and “Jin Kui”, there are approximately 30 passages related to the Xian pulse and its associated diseases, pulses, and syndromes. Many of these passages are quite complex and even difficult to understand (some scholars believe that certain passages are not original texts by Zhongjing but were added by later pulse theorists—this remains to be verified).
Here, we will discuss the relationship between the Xian pulse and pain syndromes.
The relationship between the Xian pulse and pain syndromes can be summarized as follows:
In “Shang Han Lun, Differentiating Tai Yang Disease, Pulse and Syndrome Treatment”, Article 140 states: “In Tai Yang disease, if the pulse is Xian, there must be tightness in both flanks.”
Regarding the general concept of Tai Yang disease: When external pathogens (which can refer to various external pathological stimuli) invade the body, the first to respond is the Tai Yang—Ying and Wei Qi, which resist the pathogen, leading to symptoms such as chills and fever; this is the exterior syndrome known as Tai Yang disease.
The material basis for the exterior syndrome is the righteous Qi, and the treatment method is to assist the righteous Qi in dispersing the pathogen, guiding it according to its momentum; when the pathogen is expelled, the righteous Qi can gradually recover.
If purgative herbs are mistakenly used when there is no pathological accumulation in the intestines, the bitter cold herbs stimulate the intestinal tract (such as the Da Cheng Qi Decoction), inevitably leading to increased intestinal motility, spasms, gas production, and a series of stimulating symptoms; at the same time, unjustly attacking the righteous Qi within will inevitably reduce the exterior’s resistance to pathogens, resulting in abdominal pain and even tightness and pain in both flanks, thus presenting a Xian pulse.
The formation of the Xian pulse is undoubtedly caused by pain.
This can be further elaborated in the following classical texts.
In “Jin Kui, Abdominal Fullness, Cold Hernia, Food Stagnation, Pulse and Syndrome Treatment”, Article 5 states: “If the pulse at the cun is Xian, there will be tightness and pain under the flanks, and the person will feel cold and shivery.”
Pain sensations generally occur when tissues or organs are injured or inflamed; in this sense, pain has a protective significance.
Based on the above two passages, it can be inferred that this relates to visceral referred pain (Tai Yang disease, purged) and inflammatory pain from the chest and abdominal wall.
The conduction of pain from the viscera enters the spinal cord via the visceral nerves, and through the spinal cord and thalamic tract, it corresponds to the somatic nerves in the area of the organ.
When inflammation is localized in the chest and flank membranes, since the pain conduction centers are in the spinal nerves and autonomic nerves of the spinal cord, the excitation of the sympathetic nervous system increases, leading to vasoconstriction and increased pressure, forming a Xian pulse.
The author’s understanding of the above passages can also be supported by Articles 21 and 22 in “Jin Kui, Phlegm, Cough Disease”.
It states: “If the pulse is deep and Xian, it indicates internal pain from Xuan Yin; if the disease is Xuan Yin, the Ten Jujube Decoction is the main treatment for it,”indicating that this is pain caused by inflammatory stimulation in both flanks.
Pain responses manifest as Xian pulses, and varying degrees of pain can correspond to different natures and forms of single Xian pulses or combined pulses such as Chen Xian, Xian Jin, or even Fu Xian.
For example, “Jin Kui, Abdominal Fullness, Cold Hernia, Food Stagnation, Pulse and Syndrome Treatment”, Article 17 states: “Abdominal pain, pulse Xian and tight… indicates cold hernia. Cold hernia causes pain around the navel; if it occurs, there will be spontaneous sweating, cold extremities, and the pulse will be deep and Xian; Da Wu Tou Decoction is the main treatment for it.”
From the above texts, it can be seen that varying degrees of pain can present three types of combined Xian pulses: light pain may present as a Xian pulse; more severe pain may present as a Xian Jin pulse; and unbearable pain, with cold sweat and cold extremities, will lead to rapid constriction of the blood vessels, narrowing the lumen (deep), and increasing pressure within the vessels, thus forming a deep Xian pulse. This point has been practically experienced by the author in clinical practice.
2
Understanding and Initial Insights on the Xian Pulse
Various classical pulse studies have a common concept in describing the characteristics of the Xian pulse.
The vascular wall strength of the Xian pulse is high (rigid, hard), the vessel wall is tense, and the internal pressure is high, resulting in a significant sense of resistance; the pulse at the cun, guan, and chi positions shows a forward thrusting pulsation at the cun, while the chi position exhibits a significant backward thrusting (in normal individuals, the chi pulse is generally lower).
Descriptions of the Xian pulse by various scholars include: “straight and long” (“Suwen”), “shaped like a bowstring, does not move when pressed” (“Jin Kui”), “like a taut string” (“Pulse Classic”), “does not move when pressed, feels like pressing a string” (“Treatise on the Origins of Various Diseases”), “straight through the middle, firmly pointing down” (“Pulse Classic Errors”) etc., all theoretically express the shape and characteristics of the Xian pulse.
In addition to the aforementioned vascular factors, blood flow velocity, resistance to blood flow, and blood viscosity, some literature also mentions that increased levels of adrenergic neurotransmitters in the blood vessels and neurohumoral factors are also related to the formation of the Xian pulse. This connects with the pathophysiological process of sympathetic nervous system excitation triggered by pain syndromes.
Thus, can we consider that: the Xian pulse is formed due to changes in the vascular wall, blood, neurohumoral factors, and endocrine activities.
Therefore, establishing precise qualitative and quantitative standards for the Xian pulse and organically integrating them with TCM syndrome differentiation and treatment theories is undoubtedly still quite challenging, which requires further research and exploration.
Note: This article is excerpted from “Compilation of Academic Experiences in Ningxia Traditional Chinese Medicine”, compiled in 1986. This public account uses it for academic exchange; if there is any infringement, please contact for deletion, and please indicate the source when reprinting.
The cover image is from Shetu Network.
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