In Traditional Chinese Medicine (TCM), if you can distinguish between xū (deficiency) and shí (excess), the effects will be very significant, leading to an improvement in the condition. However, many people cannot accurately identify true deficiency and excess, which can be quite frustrating.In fact, after feeling pulses for so long, I cannot claim to be 100% certain about deficiency and excess, as my skills are still developing. However, I can use a trial-and-error approach, starting with a small amount of medicine to assess deficiency and excess.
For example, if you find that a patient has a xū mài (deficient pulse), you would give them herbs to tonify qì (vital energy) and xue (blood). If after taking the herbs, the patient does not feel a sense of lightness and comfort throughout their body, and the pulse does not become softer and stronger, it indicates that there is stagnation. Moreover, if the patient feels discomfort in specific areas, such as the chest or back, you should carefully examine the guān mài (gates pulse) to see if there is yū tán (phlegm-damp) or yù mài (stagnation pulse). At this point, using herbs to resolve the stagnation will yield good results. Generally, the guān mài is prone to blockage, one related to the pí wèi (spleen and stomach) and the other to the gān (liver). Modern diets often lead to over-nutrition, causing issues with the pí wèi. The gān is mainly related to emotions, and the complexity of modern society can easily lead to emotional problems. Additionally, the cùn bù (cun position) and head are prone to stagnation, phlegm, and cold. Therefore, using herbs to resolve these issues will help to ensure smooth circulation of qì and xue.Case Study:A patient presented with the complaint: after washing her hair in the morning, water dripped into her ear, and after a while, she felt pain in her ear, suspecting inflammation. She applied anti-inflammatory medication but still experienced some facial swelling. When she came in at noon, her pulse was primarily xū, with heat in the cùn bù and cold in the right chǐ (尺). After administering Xīyángshēn (American ginseng) 0.3g, within a few minutes, she reported reduced pain. Upon checking the pulse, it had strengthened, but I found stagnation in the left guān and cold in the right chǐ. I then used Niúxī (Achyranthes) 0.2g and Bǔgǔzhī (Psoralea) 0.1g. A few minutes later, the patient’s pulse became softer, and her ear pain subsided. Since the patient had some knowledge of TCM, she asked why I didn’t use Báisháo (White Peony) since her pulse felt a bit rapid. I explained that while her pulse was rapid, it was weak upon pressure, indicating a xū jí (deficient rapid pulse); true yù mài would be strong upon pressure. Therefore, I used Xīyángshēn to tonify qì, and since her cùn bù had heat, Xīyángshēn was appropriate. Additionally, due to stagnation in the left guān, I used Niúxī to resolve it, as it can guide qì downward. Bǔgǔzhī was used because of the cold in the right chǐ.In summary, if it is a shí mài (excess pulse), using tonifying herbs will worsen the stagnation and the pulse will not become softer. In this case, using herbs to resolve the stagnation will solve the problem. If it is a xū mài, using tonifying herbs will invigorate the patient, and the overall pulse will strengthen, indicating that the treatment is correct. The best method is to first take your own pulse and observe the changes to enhance your pulse diagnosis skills, as you can perceive your body’s changes most clearly and then combine the pulse findings to judge whether your treatment is appropriate.
