The Slippery Pulse is Not Necessarily a Sign of Pregnancy
The pulse pattern of pregnancy has historically been interpreted in two different ways. For instance, the Neijing states “the Shaoyin pulse is very active” (Su Wen: Ping Ren Qi Xiang Lun) and “Yin deficiency leads to Yang counteracting” (Su Wen: Yin Yang Bie Lun). The Jin Kui Yao Lue suggests that “a woman with a normal pulse has a weak Yin pulse” (Fu Ren Ren Sheng Bing Mai Zheng Bing Zhi), while the Mai Jing states: “A pulse that is normal yet weak indicates a condition of lactation.” The Si Yan Ju Yao mentions: “A slippery pulse at the wrist indicates a favorable pregnancy.” These descriptions of pulse patterns, such as “very active” and “slippery,” indicate an excess pulse, while “weak” and “deficient” indicate a deficiency pattern. One represents excess, and the other represents deficiency, both of which are summaries of clinical practice experience. However, whether the appearance of a slippery pulse, which we commonly refer to, is indeed a sign of pregnancy is worth exploring.
The slippery pulse, as described in the Mai Jing, is characterized by “coming and going smoothly, flowing and turning, resembling a rolling bead.” Later interpretations often liken it to “smooth and flowing, like beads rolling on a plate.” The appearance of a slippery pulse can be both physiological and pathological. For instance, when external pathogenic heat invades internally, causing stagnation, or when phlegm and dampness accumulate and transform into fire, the evil qi becomes intense while the righteous qi remains strong, leading to a rapid blood flow that impacts the pulse pathway, resulting in a slippery and rapid pulse. Conversely, true Yin may be consumed, leading to deficiency of Qi and blood, where both deficient and slippery pulses can be observed. This is a common pathological slippery pulse seen in clinical practice. Physiologically, when the five organs are harmonized, and the Ying and Wei Qi are abundant, with even distribution of Qi and blood, the pulse flows smoothly and gently. In pregnant women with abundant Qi and blood, during the later stages of pregnancy, as the fetus grows, Qi and blood converge in the uterus to nourish the fetus, the pulse may become slippery and slightly rapid. If a pregnant woman is weak in constitution, even in the mid to late stages of pregnancy, the pulse may still appear thin and weak, indicating insufficient Qi and blood to nourish the fetus, necessitating timely treatment with Qi and blood tonics to ensure the health of the pregnancy and prevent miscarriage.
The appearance of a slippery pulse can be classified into physiological and pathological categories. For pregnant women, there are distinctions between those who are robust and those who are thin and weak, and the pulse patterns can also differ between excess and deficiency. Therefore, a comprehensive analysis of the woman’s constitution, the duration of amenorrhea, the manifestations of pregnancy, and her living environment is essential before drawing conclusions. One should not hastily conclude that a married woman with a slippery pulse is pregnant. Special attention should also be given to women with a weak constitution; even if a slippery pulse is not present, if they exhibit symptoms such as amenorrhea, loss of appetite, nausea, cravings for sour foods, and weakness in limbs, these signs of potential pregnancy should be carefully examined, and medication should be used cautiously to avoid adverse outcomes.
In summary, the reasons why a slippery pulse is not necessarily a sign of pregnancy can be summarized as follows: first, abundant Qi and blood, or phlegm and dampness transforming into fire, can lead to a slippery pulse; second, the differences in the constitution of pregnant women, where those with a robust constitution are more likely to exhibit a slippery pulse, while those who are weak may not show a slippery pulse but instead exhibit a thin and weak pulse. Therefore, the diagnosis of pregnancy should be based on a comprehensive assessment of the four diagnostic methods to avoid unnecessary errors.
Discussion on Slippery Miscarriage
Slippery miscarriage falls under the category of habitual miscarriage. Traditional Chinese medicine (TCM) has developed unique theoretical guidance and accumulated rich clinical experience in treating habitual miscarriage, achieving significant efficacy and gaining recognition from patients and foreign medical professionals alike. The pathogenic causes of slippery miscarriage generally include deficiency of spleen and kidney Qi, blood heat causing movement, trauma, excessive labor, irregular diet, and excessive sexual activity, leading to weakness of Qi and blood, deficiency of liver and kidney, and instability of the Chong and Ren meridians, resulting in miscarriage. Additionally, environmental pollution, chemicals, and radiation should be considered as potential harmful stimuli, particularly radioactive exposure, which may lead to the death and expulsion of the fertilized egg.
For the treatment of this condition, in addition to syndrome differentiation and treatment, two steps should be followed: first, pre-pregnancy treatment to strengthen the kidneys, and second, prevention of disease during pregnancy and early treatment if illness occurs.
The so-called pre-pregnancy treatment focuses on strengthening the kidneys. Before conception, attention should be given to nourishing kidney Qi, as the reasons for repeated miscarriages, although varied, generally stem from instability of the Chong and Ren meridians and insufficient nourishment from the kidneys. Therefore, before conception, it is essential to regulate Qi and blood, warm and nourish the Chong and Ren meridians, and focus on the kidneys to protect the foundation. Commonly used formulas include Ren Shen Yang Rong Tang (Ginseng Nourishing Decoction) with Tu Si Zi (Cuscuta), Lu Jiao Shuang (Deer Antler Velvet), and Fu Pen Zi (Raspberry), or Wu Zi Yan Zong Wan (Five-Seed Restoration Pill) without Che Qian Zi (Plantago Seed), adding Chuan Duan (Chinese Teasel), Chuan Du Zhong (Eucommia), and Sang Ji Sheng (Mulberry Mistletoe) to be taken alternately, one dose daily, for a period of six months to one year, which can often lead to successful conception.
After conception, treatment should be tailored to the pregnant woman’s constitution and strength, using appropriate medicinal treatments to prevent illness. Commonly used formulas include Tiao Gan Tang (Liver Regulating Decoction) with Huaishan Yao (Chinese Yam), Shan Zhu Yu (Cornelian Cherry), Ejiao (Donkey-hide Gel), Dang Gui (Angelica), Bai Shao (White Peony), Ba Jiao Tian (Morinda Root), and Nian Cao (Nasturtium) with Tu Si Zi, Fu Pen Zi, Sang Ji Sheng, Chuan Du Zhong, and Chuan Xu Duan to tonify the kidneys and nourish the liver, or Tai Shan Pan Shi San (Tai Shan Stone Powder) which is Shi Quan Da Bu Tang (All-Inclusive Great Tonifying Decoction) without Rou Gui (Cinnamon) and Fu Ling (Poria), adding Huang Qin (Scutellaria), Chuan Duan, Sha Ren (Amomum), and Nuomi (Glutinous Rice) to regulate Qi and blood. By treating both the pre-natal and post-natal aspects, addressing both liver and kidney, Qi and blood can be harmonized, and the fetus can be nourished, leading to a full-term delivery. If signs of fetal instability or leakage are detected, timely measures should be taken to treat both the symptoms and the root cause, ensuring the fetus is stabilized and nourishing the kidneys to stop bleeding. For cases of blood heat, irritability, dry throat, and slight vaginal bleeding, Liang Di Tang (Two-Local Decoction) can be used to nourish Yin and clear heat, while adding He Ye Ti (Lotus Leaf Stalk), Jute Root, and Han Lian Cao (Eclipta) to address the symptoms, ensuring that Yin is sufficient and the fetus is stable. For fetal instability caused by heavy lifting or trauma, both fetal pulse damage and blood stasis may be present. When selecting formulas, it is essential to focus on nourishing Qi and blood while also resolving stasis without harming the fetus. Commonly used formulas include Dang Gui Bu Xue Tang (Angelica Blood Nourishing Decoction) with Sang Ji Sheng, Tu Si Zi, Chuan Duan, Du Zhong, Ji Xue Teng (Spatholobus), and Gu Su Bu (Drynaria) to achieve both Qi and blood nourishment, kidney strengthening, and blood circulation. With the restoration of righteous Qi and resolution of blood stasis, new blood will nourish the meridians, supporting the fetus and preventing leakage.
In addition to medicinal treatment, attention should be paid to balancing work and rest, maintaining harmony of Qi and blood, and ensuring a calm spirit, avoiding excessive joy or worry, and regulating or prohibiting sexual activity to prevent damage to the Chong and Ren meridians and avoid disturbing the fetus. Dietary adjustments should ensure nutrition is rich yet mild, while also preventing excessive dryness or dampness, especially for those with a tendency towards dryness or dampness, who should pay special attention to dietary management.
These preventive and therapeutic measures focus solely on the woman herself. However, habitual miscarriage, while manifesting in women, is often related to the husband’s constitution. For instance, those who indulge in smoking and drinking often have damp-heat accumulation in the lower jiao, leading to reduced sperm motility or excessive dead sperm. Even if conception occurs, fetal development may be slow, resulting in miscarriage. Therefore, in prevention and treatment, attention should be given not only to the woman but also to the husband’s health, implementing targeted measures to ensure the woman can conceive and carry to term.
(The above two articles are selected from Chinese Century: One Hundred Clinical Practitioners of Traditional Chinese Medicine, Volume of Ban Xiuwen, published by China Traditional Chinese Medicine in 2001, pp. 321-324)
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