As the New Year approaches, families gather and indulge in feasting.
According to research, the twenty-six commonly used pulse patterns carefully selected by ancient physicians represent a rigorous and scientific combination. They not only reflect various aspects of the changes in the cun (寸) pulse but also provide multiple methods for distinguishing and analyzing complex pulse patterns. Moreover, these methods are practical, being both simple and accurate. Let’s take a look at this article!
In clinical practice, the twenty-six commonly used pulse patterns and their combined pulses can summarize the intricate and ever-changing pulse patterns, essentially meeting the needs of “differentiating syndromes and treating accordingly”.
There are many flexible methods for correct operation and skilled techniques. For example, methods such as “classification of pulse patterns”, “mutual comparison”, “knowing the common to reach the variable”, and “observing the unique”.
1
Identifying and Analyzing Pulse Patterns Reflecting Pulse Position
Pulse patterns reflecting pulse position are divided into four categories: 1. Floating pulse, 2. Neither floating nor sinking pulse, 3. Sinking pulse, 4. Hidden pulse. The identification method is to first determine the finger strength used to press the cun position “to the bone”. Then, use the corresponding finger strength to identify which part of the cun pulse it is located. Based on the sequence of the cun pulse in the “five positions”, the changes in pulse position can be accurately identified.
For ease of discussion, we temporarily refer to the finger strength used to “press to the bone” as “total finger strength”. Based on “total finger strength”, one can specifically grasp the corresponding finger strength for examining the “five positions”.
For example: to identify a floating pulse, the finger strength used should not exceed “two-fifths of the total finger strength”. To identify a sinking pulse, the finger strength should be greater than “three-fifths of the total finger strength”. To identify a pulse that is neither floating nor sinking, the finger strength used should be between “two-fifths and three-fifths of the total finger strength”. If the pulse cannot be touched with “total finger strength” and requires more than “total finger strength” to touch, it is a hidden pulse. Using the above methods, the changes in pulse position can be accurately identified. Other pulse patterns that are based on changes in pulse position are combined pulses. For example, the “ruo pulse” is “thin and soft” combined with “floating”, while the “weak pulse” is “thin and soft” combined with “sinking”. Furthermore, the “floating rapid pulse” is a combination of “floating pulse” and “rapid pulse”, while the “sinking rapid pulse” is a combination of “sinking pulse” and “rapid pulse”. Clearly, these are very accurate identification methods.
In analyzing changes in pulse position, it is generally believed that floating pulse indicates exterior conditions, while sinking pulse indicates interior conditions; this is a general rule. In clinical diagnosis, if the exterior condition pulse is not floating or the interior condition pulse is not sinking, its diagnostic significance is even more important. It is essential to analyze the general rules of pulse position changes and their special meanings together to fully reflect the diagnostic significance of pulse position changes.
For example, in the “Treatise on Cold Damage”, Article 92 states: “If a patient has fever and headache, and the pulse is sinking, if there is no error, and the body aches, one should rescue the interior with the Si Ni Decoction.” Article 301 states: “In Shaoyin disease, if it begins with fever and the pulse is sinking, it is treated with Ma Huang, Fu Zi, and Xi Xin Decoction.” Both of these articles discuss “exterior conditions”, but the pulse is not “floating” but rather “sinking”. In this case, the comprehensive analysis of pulse and syndrome is very important. The first article discusses a patient with fever, headache, and body aches, which belongs to the Taiyang exterior condition, and the pulse should be “floating” but is instead “sinking”, indicating a deficiency of Yang Qi and a heavier interior deficiency, hence the use of Si Ni Decoction to rescue the interior, which embodies the concept of resolving the exterior while rescuing the Yang from reversal.
This indicates that the “Treatise on Cold Damage” does not abandon the pulse in favor of the syndrome when “pulse and syndrome do not match”, thus reflecting the guiding role of pulse position changes in “differentiating syndromes and treating accordingly”. Article 301 discusses the condition of Tai Shao Yin. The disease is in the Shaoyin, and it should not have fever but instead has fever, hence it is called “reversal”. This “fever” is due to the external invasion of wind-cold at the exterior. The sinking pulse indicates that the heart and kidney Yang is insufficient to promote. The “Treatise on Cold Damage” does not arbitrarily discard or select based on “pulse and syndrome not matching”, but rather analyzes the pathological mechanisms within the “common” and “variable” of pulse patterns and symptoms, clarifying the internal reasons for the mismatch between pulse position changes and symptoms, and seeking appropriate treatment methods. The internal reason is the usual deficiency of heart and kidney Yang combined with the invasion of wind-cold, hence the use of Ma Huang, Fu Zi, and Xi Xin Decoction to resolve both exterior and interior. These examples illustrate that the analysis of pulse position changes should broaden one’s thinking and not be limited to the general understanding of “certain pulses indicate certain syndromes”. If the pulse and syndrome do not match, a deeper analysis is even more necessary.
2
Identifying and Analyzing Pulse Patterns Reflecting Changes in “Zhi Shu” (Pulse Rate)
Pulse patterns reflecting changes in “Zhi Shu” are divided into three categories: 1. Slow pulse, 2. Normal pulse rate, 3. Rapid pulse. The complex changes in “Zhi Shu” in clinical practice can be summarized into these three categories. Other pulse patterns that are based on changes in “Zhi Shu” are combined pulses. For example, the “cuo pulse” is a “rapid” pulse combined with “one stop at a time”. Additionally, the sinking slow pulse is a combination of slow pulse and sinking pulse, while the sinking rapid pulse is a combination of rapid pulse and sinking pulse.
Changes in “Zhi Shu” are easiest to identify and can be measured using “breath counting” or “timing methods”. It is generally believed that the normal pulse rate is between four to five beats per breath. Three beats per breath or fewer are considered slow pulse. Six beats per breath or more are considered rapid pulse. According to the timing method, a pulse rate of fewer than 50 beats per minute is a slow pulse, while a normal pulse rate is between 60-90 beats per minute. If it exceeds the normal pulse rate, it is considered a rapid pulse. The pulse rate in children should be discussed separately.
In analyzing changes in “Zhi Shu”, it is generally believed that rapid pulse indicates heat, while slow pulse indicates cold. However, this is merely the most general diagnostic significance of the slow and rapid pulses. Practical experience has shown that the slow and rapid pulses are indeed of great practical value in analyzing the cold and heat of diseases. In addition, the changes in pulse rate have broader significance.
For example, organic and functional heart diseases, as well as pain syndromes, phlegm syndromes, and fluid syndromes, can all provide diagnostic evidence through changes in pulse rate. Especially in cases of “pulse and syndrome not matching”, the analysis of changes in pulse rate is particularly important.
For instance, in Article 213 of the “Treatise on Cold Damage”, it states: “In Yangming disease, if the pulse is slow, even if sweating occurs, and there is no aversion to cold, the body must be heavy, with shortness of breath, abdominal fullness, and wheezing, and tidal fever, in addition to wanting to relieve, one can attack the interior. If the hands and feet sweat profusely, this indicates that the stool is hard, and Da Cheng Qi Decoction is the treatment.” This article discusses a slow pulse, which is neither deficient nor cold, but rather indicates a Yangming bowel heat syndrome. In this case, it is essential to analyze the causes of the slow pulse and not assume it is “pulse and syndrome not matching”. The reason for the slow pulse is that the heat is obstructed in the interior, causing stagnation of Qi and blood, and the Yang Qi is restrained, which can also lead to a slow pulse. Therefore, Da Cheng Qi Decoction can be used to purge the interior heat and eliminate dryness and obstruction.
This indicates that traditional Chinese medicine has a unique understanding of changes in pulse rate, and it is necessary to clarify the causes, nature, disease location, and the diseases they indicate, as well as their interrelationships, to fully reflect the diagnostic significance of changes in pulse rate. For example, the “cuo pulse” is essentially a rapid pulse with a “one stop at a time” change, indicating “Yang excess and Yin deficiency” or “extreme heat injuring Yin”, which is a pathological mechanism guided by traditional Chinese medicine theory.
Thus, although the pulse rate is merely the number of heartbeats, under the guidance of traditional Chinese medicine theory, changes in pulse rate have very broad diagnostic significance. Therefore, the analysis of changes in pulse rate should reflect the guiding role of traditional Chinese medicine theory while also considering that changes in pulse rate are fundamentally variations in heartbeats. Combining both aspects can better reflect the diagnostic significance of changes in pulse rate.
3
Identifying and Analyzing Pulse Patterns Reflecting Pulse Size
Pulse patterns reflecting pulse size are divided into three categories: 1. Normal pulse size, 2. Hong pulse (surging pulse), 3. Thin pulse. The sizes of pulses that can be felt in clinical practice fall into these three categories. Other pulse patterns that are based on the pulse being “large” or “thin” are combined pulses. For example, the “xu pulse” is a “large” pulse combined with conditions such as “slow, empty, soft”, while the “wei pulse” is a “thin” pulse combined with “soft”.
The identification of pulse size is based on the normal pulse size. If it is larger than the normal pulse size, it is a Hong pulse. If it is smaller than the normal pulse size, it is a thin pulse. The standard for normal pulse size varies from person to person and can be determined by referring to the method of dividing the “five positions”.
In analyzing pulse size, it is generally believed that Hong pulse indicates fullness and heat, while thin pulse indicates deficiency. In fact, this is a general rule for the Hong and thin pulses. In addition, both of these pulse patterns have very broad diagnostic significance.
For example, regarding the Hong pulse, the “Pulse Science Elucidation” states: “If after a long illness there is deficiency, or if there is deficiency due to blood loss and this pulse appears, it is a bad sign of Yang excess and Yin deficiency.” Although this pulse pattern is a Hong pulse, it does not necessarily indicate fullness; it can certainly indicate a true organ pulse of “stomach Qi has been exhausted”. Otherwise, it may not be a “bad sign of Yang excess and Yin deficiency”. This indicates that the main diseases of the Hong and thin pulses cannot be generalized. It is essential to conduct a comprehensive analysis in conjunction with combined pulses and clinical manifestations. Ancient physicians determined the deficiency and fullness pulses as commonly used pulse patterns, which is one aspect of the comprehensive analysis of the nature of the Hong pulse and its main diseases. Therefore, based on the Hong pulse, one should further differentiate between deficiency and fullness, and not assume that all Hong pulses indicate fullness syndrome.
The analysis method of pulse patterns and their main diseases in the “Treatise on Cold Damage and Miscellaneous Diseases” is a method worth advocating. This method integrates pulse, disease, symptoms, and treatment, conducting a comprehensive analysis, and flexibly applying pulse diagnosis in clinical practice. This is the most significant method to reflect the diagnostic role of pulse diagnosis.
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Identifying and Analyzing the Smoothness of the Pulse
Hua (slippery) and Se (rough) pulses reflect the smoothness of the pulse. The smoothness of the pulse is divided into three categories: 1. Normal smoothness. 2. More smooth than normal, i.e., Hua pulse. 3. Less smooth than normal, i.e., Se pulse. Among them, normal smoothness is a necessary condition for normal pulse patterns.
The Hua and Se pulses indicate that the smoothness of the pulse has changed. Therefore, one can accumulate experience in identifying Hua and Se pulses by understanding the comprehensive performance of normal pulses.
The identification methods for Hua and Se pulses are difficult to master. This is because the smoothness of the pulse must be judged based on various changes in the pulse. However, the purpose is not to examine other changes in the pulse but specifically to assess the smoothness of the pulse. Therefore, identifying Hua and Se pulses is relatively challenging. The key technique is to press the finger on the ridge of the cun pulse, carefully observing the smoothness of the blood flow within the pulse vessel, and then combining it with other changes for a comprehensive understanding. If the blood flow within the pulse vessel is smooth and more so than normal, it is a Hua pulse. If the flow is difficult and less smooth than normal, it is a Se pulse. The smoothness of the pulse does not have specific indicators; it is difficult to repeatedly experience the comprehensive performance of normal pulses, so one must strengthen basic practice and accumulate experience in examining the smoothness of normal pulses to accurately identify Hua and Se pulses.
In analyzing Hua and Se pulses, it is generally believed that Hua and Se pulses are opposites, with opposite natures. However, their main diseases and diagnostic significance should not be confined to the “opposite” or “contrary” forms. Some pulse texts habitually discuss pulse patterns and their main diseases in terms of “opposite” or “contrary” forms, which indeed facilitates the distinction of pulse shapes and natures but does not accurately express the diagnostic significance of pulse patterns. Moreover, if one is confined to this form, it makes the flexible pulse methods rigid and inflexible, which is not conducive to the important role of pulse diagnosis. For example, the main diseases of Hua pulses often belong to conditions of excess evil, but the main diseases of Se pulses can be either deficiency or excess, and one cannot assume that Se pulses must indicate deficiency just because Hua pulses indicate “excess”. Furthermore, the main diseases of Hua pulses are not necessarily all excess syndromes. Therefore, the analysis of the main diseases of Hua and Se pulses must be based on the specific analysis of the smoothness of the pulse and cannot be generalized.
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Identifying and Analyzing the Xuan Pulse
The Xuan pulse reflects the tension of the pulse, and its essence is the increased tension of the pulse. If the cun pulse has normal tension, it is generally considered a “wei xuan” (slightly taut) pulse, which indicates the presence of stomach Qi, specifically manifested as a pulse that is taut yet “gentle”. Not all Xuan pulses indicate disease; there are distinctions between those indicating “normal”, “disease”, and “death”, primarily depending on the amount of stomach Qi, which can be distinguished by the degree of “gentleness” of the Xuan pulse. The Xuan pulse indicating “disease” is the Xuan pulse with “less stomach Qi”. The Xuan pulse indicating “death” indicates that stomach Qi has been exhausted, representing the degree of “true organ pulse”, hence indicating death.
The identification method for the Xuan pulse is: first touch the pulse body, then apply pressure to the pulse body, with the finger feeling characteristic being “pressed like a bowstring”; if the finger is lifted, the pulse body does not rise with the hand. This is a manifestation of increased tension of the pulse body.
The Xuan pulse has a high occurrence rate, and historical pulse texts have recorded many instances of the Xuan pulse and its main diseases. It is generally believed that there are physiological and pathological Xuan pulses. Physiological Xuan pulses correspond to the liver pulse and the seasonal pulse of spring. Pathological Xuan pulses are often caused by abnormal dispersal, obstructed Qi mechanism, and disharmony of Qi and blood. Their main diseases often include liver and gallbladder disorders or cold syndromes, pain syndromes, phlegm syndromes, Qi stagnation, blood stasis, and other conditions. In addition to some common diseases, the Xuan pulse also indicates conditions such as fluid retention, hanging fluid, and other diseases.
The “Pulse Classic” states: “The malarial pulse is self-Xuan”. The “Pulse Science Elucidation” states: “The pulse of hepatitis is often Xuan”. This indicates that ancient physicians’ analysis of the Xuan pulse and its main diseases is closely related to common or frequently occurring diseases, continuously integrating new knowledge and gradually accumulating experience, rather than being confined to a rigid form of “matching pulse and syndrome”.
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Identifying and Analyzing the Jin and Huan Pulses
The Jin pulse and Huan pulse are opposites in nature. The Jin pulse essentially indicates that the pulse body is “tense” or “constricted”, while the Huan pulse indicates that the pulse body is “relaxed” or “loose”. Both of these pulse patterns are pathological pulses, and there is no such thing as a “normal pulse”. The identification method is: the Jin pulse has a “tense” or “constricted” pulse body, with a finger feeling characteristic of “bouncing left and right” or “like cutting a rope”. The Huan pulse has a “relaxed” or “loose” pulse body, with a finger feeling characteristic of low “tension” or “elasticity”.
The Huan pulse should be distinguished from the slow pulse. The “Pulse Classic” warns that later generations should not confuse the slow pulse with the Huan pulse, and the preface specifically explains: “If Huan is taken as slow, then danger will come immediately.” This serves as a reminder to later generations that the “Huan pulse” and the “slow pulse” must be strictly distinguished. Otherwise, misdiagnosis and mistreatment may occur, even leading to serious consequences. The fundamental difference between the two is: the slow pulse examines changes in pulse rate, while the Huan pulse examines the degree of “relaxation” or “looseness” of the pulse body. They must never be confused.
The Jin pulse should be distinguished from the Xuan pulse. The difference is that the Xuan pulse merely indicates increased tension of the pulse body, pressed like a bowstring. The Jin pulse, however, indicates that the pulse body is “tense” or “constricted”, and has a finger feeling characteristic of “bouncing left and right” or “like cutting a rope”. These two pulse patterns have certain differences in shape and degree. Therefore, the Xuan pulse can be both a normal and pathological pulse, while the Jin pulse is always a pathological pulse.
Some pulse texts have misunderstood the normative and practical significance of the Huan pulse, leading to some inappropriate analyses of the Jin or Huan pulses. For example, the “Correct Eye of the Diagnostician” states: “Huan is the stomach pulse, not indicating disease, only when combined can it be used to determine the syndrome.” In fact, this misunderstands the concept of “Huan pulse” and “pulse coming gently”. In reality, “pulse coming gently” is the stomach pulse. The “Huan pulse” is not the pulse coming gently; these are two concepts that must not be confused. Therefore, saying that the Huan pulse “does not indicate disease” is incorrect, and saying that “only when combined can it be used to determine the syndrome” is also incorrect. For example, in Article 2 of the “Treatise on Cold Damage”, it states: “In Taiyang disease, if there is fever, sweating, and aversion to wind, and the pulse is Huan, it is called wind stroke.” This is an instance of diagnosing based solely on the Huan pulse. This indicates that the “Treatise on Cold Damage” does not misunderstand the normative and practical significance of the Huan pulse.
Furthermore, in Article 3 of the “Treatise on Cold Damage”, it states: “In Taiyang disease, whether there is fever or not, there must be aversion to cold, body pain, vomiting, and the pulse is tight on both Yin and Yang, it is called cold damage.” This article corresponds with the second article, indicating that the Jin pulse and Huan pulse are opposites in nature. Therefore, it is necessary to clarify the misunderstandings and misstatements regarding the Huan pulse, and it should not be regarded as a manifestation of a normal pulse.
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Identifying and Analyzing the Long and Short Pulses
Identifying the long and short pulses is very simple. According to the operational norms of the “holding pulse light and heavy method”, if the cun pulse is excessively positioned at the cun and chi ends, it is a long pulse. If the cun and chi ends are insufficiently positioned, it is a short pulse.
Long pulses generally indicate a strong constitution. Short pulses, while not typical of normal pulses, do not necessarily indicate a pathological pulse. For example, if a short pulse is found in a short person without other discomfort, it may not be considered a pathological pulse.
It is generally believed that long pulses often indicate excess conditions, while short pulses often indicate deficiency conditions. In fact, this is a general rule. For example, short pulses are not all indicative of deficiency; in clinical practice, it is not uncommon for short pulses to occur due to Qi stagnation, Qi reversal, or obstructed Qi mechanism. Therefore, the identification and analysis of long and short pulses and their main diseases should not be based solely on general rules, nor should they be formalized.
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Identifying and Analyzing the San Pulse
San pulse can be divided into physiological and pathological types. Physiological San pulse is characterized by a “large” pulse body that objectively presents a “scattered” appearance, but the pulse body is rounded and without other discomfort. Pathological San pulse has a pulse shape that is not rounded, excessively scattered, or overly broad, even to the point where the boundary between the pulse vessel and surrounding tissues is unclear. The main difference between physiological and pathological San pulses is the degree of scattering. Therefore, the identification and analysis of San pulse primarily depend on the degree of scattering.
In modern times, the application of San pulse has decreased. The reason for this is that modern pulse texts have not understood the normative and practical significance of San pulse. Therefore, the analysis of San pulse and its main diseases in modern pulse texts is indeed lacking.
In modern pulse texts, San pulse is described as “floating and scattered without root”. This is actually just one degree of San pulse, which can only be seen in critical conditions. In fact, San pulse is not necessarily limited to this degree.
As one of the commonly used pulse patterns, San pulse does not require “floating and scattered without root” as a necessary condition, nor is it only seen in critical conditions. It can be both a pathological pulse and a normal pulse, and sometimes it can even indicate a favorable sign of recovery from illness. For example, the “Suwen Pulse Essentials” states: “If the heart pulse beats long, and the tongue cannot speak, its soft and scattered nature indicates that it will resolve itself. If the lung pulse beats firm and long, and there is blood sputum, its soft and scattered nature indicates that it will cause sweating, leading to no further scattering. If the liver pulse beats firm and long, and the color is not green, it indicates that there is a drop in the pulse, as blood is in the hypochondrium, causing shortness of breath. Its soft and scattered nature indicates that it will cause fluid retention, which is thirst and excessive drinking, easily entering the skin, muscles, and intestines. If the stomach pulse beats firm and long, and its color is red, it indicates that it will cause a fracture, and its soft and scattered nature indicates that it will cause food stagnation. If the spleen pulse beats firm and long, and its color is yellow, it indicates that it will cause shortness of breath, and its soft and scattered nature indicates that it will cause foot swelling, resembling water. If the kidney pulse beats firm and long, and its color is yellow and red, it indicates that it will cause a fracture, and its soft and scattered nature indicates that it will cause blood deficiency, leading to no recovery.” The so-called soft and scattered nature refers to the pulse shape of San pulse. Clearly, its main diseases vary in severity and can also indicate a favorable sign of recovery from illness. The so-called “self-resolving” indicates recovery from illness. This indicates that San pulse should not be regarded as a pulse pattern only seen in critical conditions.
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Identifying and Analyzing the Kou Pulse
The Kou pulse is a special pulse shape. It combines multiple conditions such as “floating, large, soft, central empty, and both sides solid”, with the basic characteristics being “central empty, soft, and both sides solid”. Its essence is a significant depletion of body fluids and blood, resulting in insufficient blood volume in the pulse vessel, leading to a pulse shape change that is inconsistent with the amount of blood loss. Therefore, the Kou pulse is not frequently seen in clinical practice and is often a transient pulse pattern. If the Kou pulse appears in chronic diseases, it indicates extremely poor self-regulatory function.
The history of pulse diagnosis development shows that ancient physicians have consistently recognized “central empty, both sides solid” as the basic characteristics of the Kou pulse, and there is generally no dispute about this. Therefore, the identification and analysis of the Kou pulse are relatively consistent. For example, if a patient has lost blood and presents with a Kou pulse, it indicates that the blood vessels are constricted and the amount of blood loss is inconsistent. If the amount of blood loss is excessive, the blood vessels should be “empty” and should constrict accordingly. If the body’s blood loss regulatory function is good, the blood vessels should constrict in accordance with the amount of blood loss. If there is a delay in the adaptive constriction of the blood vessels, it indicates that the blood loss regulatory function is poor. This is a method used by ancient physicians to analyze the functional state of the body reflected by pulse patterns.
This analytical method has very important significance in clinical practice. In clinical practice, special attention should be paid to analyzing the functional state of the body based on changes in pulse patterns, which is one of the important roles of pulse diagnosis that must not be overlooked.
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Identifying and Analyzing the Xu and Shi Pulses
The Xu and Shi pulses are based on the premise of a “large” pulse body. The actual significance of these two pulse patterns is to differentiate between deficiency and excess based on a “large” pulse body. If the pulse body is not “large”, then the conditions for forming Xu and Shi pulses are not met.
It is generally believed that a “large” pulse body indicates excess, while a “thin” pulse body indicates deficiency. In fact, this is a general rule. A “large” pulse body does not always indicate excess, and further differentiation and analysis are necessary. The Xu and Shi pulses are specifically aimed at this situation. The identification method is: based on a “large” pulse body, if combined with conditions such as “slow, empty, soft”, it is a Xu pulse, indicating deficiency syndrome. If it is “large and long” combined with a “slightly strong” manifestation, it is a Shi pulse, indicating excess syndrome.
In clinical practice, the pulse body that can be diagnosed and felt, apart from normal pulses, falls into the categories of Hong and thin. “Hong” represents a category larger than normal, while “thin” represents a category smaller than normal. Therefore, differentiating between deficiency and excess based on a “large” pulse body is a very important aspect. Ancient physicians reformed the Xu and Shi pulses and listed them as commonly used pulse patterns, which is precisely the purpose of this.
Since the Xu and Shi pulses are combined pulses, their nature is very clear, so the analysis of the main diseases of Xu and Shi pulses is relatively simple; all Xu pulses belong to deficiency syndromes, and all Shi pulses belong to excess syndromes.
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Identifying and Analyzing the Wei, Ru, and Ruo Pulses
The Wei, Ru, and Ruo pulses are based on the premise of a “thin and soft” pulse body. Among them, the Wei pulse does not combine with other conditions. The Ru pulse combines with “floating”. The Ruo pulse combines with “sinking”. These three pulse patterns have similarities and differences and should be distinguished. If the pulse body is not “thin and soft”, then the basic conditions for forming these three pulse patterns are not met.
Due to misunderstandings in modern pulse texts regarding the normative and practical significance of the Wei pulse, it is mistakenly believed that the Wei pulse can only be seen in critical conditions. Therefore, this has affected the identification and analysis of the above three pulse patterns. In fact, from the perspective of pulse shape norms and practical significance, the Wei pulse has an allowable range of variation and can have different degrees. Therefore, the Wei pulse is not necessarily a pulse pattern seen only in critical conditions. The Ru and Ruo pulses both contain the conditions for the Wei pulse, i.e., a “thin and soft” pulse body. On the basis of a “thin and soft” pulse body, if combined with “floating”, it is a Ru pulse; if combined with “sinking”, it is a Ruo pulse.
This indicates that these three pulse patterns are not only seen in critical conditions. Therefore, the analysis of these three pulse patterns and their main diseases should be based on the degree of manifestation at the time and should not be generalized. However, overall, these three pulse patterns reflect that the patient’s physical condition is relatively poor, with insufficient Qi and blood, mostly belonging to deficiency syndromes or deficiency with some excess.
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Identifying and Analyzing the Dong Pulse
The identification of the Dong pulse is generally done by matching the pulse shape recorded in ancient literature; if it matches, it is a Dong pulse, and if it does not, it is not a Dong pulse. This identification method is too mechanical and rigid. As a result, very few people have seen the Dong pulse. The reason is that the normative and practical significance of the Dong pulse has not been clarified.
Due to the difficulty in understanding the classic literature on pulse diagnosis, the actual significance of the Dong pulse has been buried. Based on the records in the “Treatise on Cold Damage and Miscellaneous Diseases” and the “Pulse Classic”, the actual significance of the Dong pulse can be excavated again. It has been confirmed that the Dong pulse is a pulse shape of non-sinusoidal heart rhythm. Therefore, the identification of the Dong pulse should be combined with the characteristics of non-sinusoidal heart rhythm pulse shapes, and it should not be strictly matched to the pulse shape recorded in ancient literature. The identification method can be flexibly mastered. For example, the “Pulse Classic” states: “The Dong pulse is seen at the Guan position, without head or tail, like a bean, shaking and moving.” The “Pulse Classic” also states: “The cun pulse on the left hand is slightly moving, sometimes large and sometimes small, uneven, from the cun to the Guan, from the Guan to the Chi, in all three positions, moving differently.” This indicates that ancient physicians did not use a single method to identify the Dong pulse. As long as it is clear that the Dong pulse is a pulse shape of non-sinusoidal heart rhythm, identifying the Dong pulse is not difficult and is not uncommon in clinical practice.
In analyzing the main diseases of the Dong pulse, it is essential to combine the essence of the Dong pulse; if one only analyzes based on pulse shape, it often strays too far from the topic.
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Identifying and Analyzing the Jie Pulse
The identification method for the Jie pulse is very simple; any pulse that has “intermittence” is a Jie pulse. It should be noted that if the pulse is “rapid” and intermittently has “stops”, it is a Cuo pulse. This is a pulse pattern differentiated from the Jie pulse due to its different diagnostic significance. Therefore, the Jie pulse and Cuo pulse should be distinguished.
The Jie pulse primarily reflects arrhythmia, equivalent to modern medicine’s sinus arrest. The Cuo pulse, in addition to reflecting arrhythmia, can also indicate changes in the cold-heat attributes of the disease, which is important for distinguishing the “Jue” syndrome of cold and heat. The analysis of the Jie and Cuo pulses and their main diseases should consider both arrhythmia and reflect the unique theoretical aspects of traditional Chinese medicine. For example, the Cuo pulse appears on the basis of a rapid pulse, but traditional Chinese medicine believes that this is a pathological mechanism of “Yang excess and Yin deficiency” or “extreme heat injuring Yin”. This is an understanding guided by traditional Chinese medicine theory.
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Wei Pulse
(1) Pulse Pattern
The Wei pulse is floating and can be felt, extremely thin and weak, like fat floating on soup, pressing it feels like it is about to disappear, as if it is there and not there. In some medical texts, when referring to the Wei pulse, many do not mean the Wei pulse but rather use it as an adjective, meaning “a little” or “slightly”. For instance, in the “Suwen: Discussion on the Qi of the Balanced Person”, it states: “In the long summer, the stomach pulse is slightly soft.” This means it is slightly soft. If one considers this as the Wei pulse, it should be seen as weak stomach Qi rather than a normal pulse.
(2) Similar Pulses
The Wei pulse is floating, thin, and weak, similar to the thin, weak, and Ru pulses, and should be distinguished.
1. Wei vs. Ruo:Both are extremely thin and weak, but the pulse positions are different. The Wei pulse is seen at the floating position, while the Ruo pulse is seen at the sinking position.
2. Wei vs. Thin:Although both pulses are thin, the Wei pulse is thinner than the thin pulse. The thin pulse does not emphasize pulse position or pulse strength; as long as the pulse body is thin, it is a thin pulse. The Wei pulse, while thin, must be floating and weak, pressing it feels like it is about to disappear.
3. Wei vs. Ru:The characteristics of the Ru pulse are also described as floating and soft. The author does not agree with this view. Because Ru means soft, there are no special limitations on pulse position, pulse body, or pulse rate; as long as the pulse feels soft, it is a Ru pulse. If one defines the floating and soft as Ru, it becomes difficult to distinguish from the Wei pulse, at most saying that Wei is thinner and weaker than Ru, but in fact, they can be regarded as one pulse.
(3) Pulse Theory and Main Diseases
The pulse’s beating relies on the fullness of Yin blood and the promotion of Yang Qi. When both Qi and blood are deficient, the pulse loses the fullness of blood and becomes thin; the pulse loses the promotion of Qi and becomes weak; blood deficiency cannot be contained internally, and Qi deficiency cannot stabilize its position and overflows, hence the pulse is floating, resulting in the formation of the floating, thin, and weak Wei pulse. As the “Pulse Science Elucidation” states: “Wei indicates insufficient Qi and blood, and weak Yang Qi.”
1. Qi and Blood Weakness
When Qi and blood are weak, they cannot fill and promote the blood vessels, resulting in a Wei pulse. As stated in the “Jin Kui: Water Qi Disease Chapter”: “If it is Wei, there is no stomach Qi.” In the “Jin Kui: Vomiting and Hiccups Chapter”: “If it is Wei, there is no Qi.”
2. Yang Qi Deficiency
When Yang Qi is deficient, it cannot promote the blood vessels, and the pulse can also be Wei. Symptoms include aversion to cold, cold limbs, lethargy, excessive sleep, vomiting, diarrhea, and abdominal fullness, often seen in the Shaoyin chapter. For example, in the “Treatise on Cold Damage”, Article 281 states: “In Shaoyin disease, the pulse is thin and weak, desiring to sleep.” Article 286 states: “In Shaoyin disease, the pulse is thin, and sweating is not allowed, due to the loss of Yang.”
3. Evil Departed, Zheng Not Yet Recovered
In chronic diseases, the Wei pulse is generally treated as a deficiency. In new diseases, when the evil has departed but the Zheng has not yet recovered, the Wei pulse indicates a sign of recovery. For example, in the “Treatise on Cold Damage”, Article 287 states: “In Shaoyin disease, the pulse is tight, after seven or eight days, if there is diarrhea, the pulse is suddenly thin, and the hands and feet are warm, the pulse tightens and departs, indicating recovery, even if there is diarrhea, it must recover.” Article 254 states: “If the pulse is thin and there is little sweating, it indicates self-harmonization.” In the “Jin Kui: Vomiting Chapter”: “If the pulse is thin and rapid, it indicates a desire to stop, even if there is fever, it does not lead to death.” Of course, this type of Wei pulse is not necessarily the floating, thin, and weak Wei pulse; it can also refer to a pulse that is gentle or weak and lacks strength, all of which indicate that the evil has departed, and the Zheng Qi has not yet recovered, indicating a sign of recovery.
(4) Wei Pulse Indicates Excess Analysis
The “Jin Kui: Abdominal Fullness and Food Stagnation Chapter” states: “If the cun pulse is floating and large, pressing it feels rough, and the chi pulse is also thin and rough, it indicates food stagnation, and Da Cheng Qi Decoction is the treatment.” Since the pulse has been identified as Wei, it is still treated with Da Cheng Qi Decoction, suggesting that this Wei pulse must indicate obstruction of evil. The “Pulse Theory Seeking Truth” also states: “If there is extreme pain and the pulse is closed, the pulse is seen as sinking, with a hot face, indicating that the evil has not yet resolved, and both Yin and Yang are stagnant, and the pulse is seen as Wei. If one considers Wei as a deficiency sign and does not act to purge or release, how can one unblock the stagnation of evil Qi?”
Thus, the Wei pulse indicates evil excess; I believe otherwise. The aforementioned Wei pulse is actually a sinking pulse, or a sinking and rough pulse, not the floating, thin, and weak Wei pulse. Jing Yue states: “The Wei pulse should generally be treated as a deficiency.” This indeed has insight.
15
Identifying and Analyzing the Geng Pulse
The Geng pulse reflects the changes in the pulse, and identifying changes in pulse patterns is crucial for determining whether the pulse pattern indicates disease and the development of the disease. However, modern pulse texts have misunderstood the actual significance of the Geng pulse, mistakenly defining it as “the pulse comes to a stop, with a fixed number of stops, and then returns after a long time”, leading some pulse texts to stray too far from the identification and analysis of the Geng pulse and its main diseases.
Based on classic pulse diagnosis literature, the actual significance of the Geng pulse can be excavated again. It has been confirmed that the Geng pulse primarily reflects changes in the pulse, which is an important aspect of pulse diagnosis and analysis.
For example, according to the seasonal changes in pulse patterns, the pulse in spring should exhibit a Xuan pattern. If the pulse in spring is not Xuan, it indicates that the changes in the pulse are abnormal, which is significant for analyzing whether the pulse pattern indicates disease. Using this method, one can determine whether the pulse patterns throughout the four seasons correspond to the “four seasons” and whether they indicate disease. Additionally, one can conduct a comprehensive analysis based on the theory of the five elements to clarify the internal relationship between pulse patterns and diseases. For instance, if a woman is three months pregnant, her pulse should exhibit a Hua pattern. If her pulse is not Hua but Se at three months of pregnancy, it indicates that the changes in the pulse are abnormal, and the fetal essence is not nourished. These examples illustrate that identifying and analyzing changes in the Geng pulse has very important diagnostic significance. Therefore, the Geng pulse should not be regarded as a pulse with intermittent patterns, as this contradicts the actual significance of the Geng pulse.
16
Identifying and Analyzing Changes and Transformations in Pulse Patterns
During the course of a disease, changes or transformations in pulse patterns occur, transitioning from one pulse pattern to another, which ancient physicians referred to as “Ge pulse”. The changes in the pulse have certain rules, and the changes and transformations in pulse patterns during the course of a disease also have certain rules. The Geng pulse and Ge pulse respectively identify and analyze pulse patterns based on these two aspects of rules, which distinguishes the Geng pulse from the Ge pulse.
When ancient physicians diagnosed pulses, they examined both the changes in the Geng pulse and whether the changes in pulse patterns during the course of the disease conformed to the rules, which is crucial for analyzing the pathological mechanisms. The more experience one has, the more significant the importance of these two pulse patterns becomes. However, due to the difficulty in understanding the expression methods of the “Pulse Classic”, the actual significance of these two pulse patterns has been buried.
Research shows that modern pulse texts have buried the actual significance of the Geng and Ge pulses, causing current pulse diagnosis methods to lose their original flexibility. Moreover, this has had a very negative impact on the full utilization of pulse diagnosis’s diagnostic role. Therefore, when comparing current pulse diagnosis methods with those recorded in classic literature, they indeed appear inferior.
From the records in classic pulse diagnosis literature, the methods developed by ancient physicians for pulse diagnosis are not only very practical but also flexible. However, since the “Pulse Classic”, pulse diagnosis has undergone changes, losing its original flexibility and adaptability. The main reason for this is that the expression methods of classic pulse diagnosis literature are difficult to understand, and the actual significance of some pulse names has been buried, leading to the loss of some practical techniques in pulse diagnosis. Among them, the Geng and Ge pulses do not specifically refer to a certain pulse shape but represent two important methods for identifying and analyzing changes in pulse patterns. The Geng pulse is identified and analyzed based on physiological pulse pattern changes, while the Ge pulse is identified and analyzed based on pathological pulse pattern changes.
Therefore, the clinical application of these two pulse patterns is the most flexible and adaptable, as they can be used to diagnose whether pulse patterns indicate disease, analyze the internal relationship between pulse patterns and diseases, and diagnose the development and prognosis of diseases.
For example, the “Pulse Classic” states: “The three-position pulse changes; if a long illness leads to death, a sudden illness leads to life.” Undoubtedly, this specifically refers to the changes and transformations in pulse patterns during the course of a disease. It means that if a sudden illness causes the pulse to change and transform, it indicates that the body’s adaptability or regulatory function is still good, which is a manifestation of vitality in the pulse, hence it is said to “sudden illness leads to life”. If the disease has lasted a long time and the pulse only changes and transforms then, it indicates that the body’s adaptability or regulatory function is poor, which is a manifestation of lack of vitality in the pulse, hence it is said to “long illness leads to death”.
For instance, in patients with excessive blood loss, their pulse should be sinking and thin, which conforms to the development rules. If it does not transform into a sinking and thin pulse, it does not conform to the rules, indicating that the blood loss regulatory function is too poor, which is a manifestation of lack of vitality in the pulse. As Bian Que said: “If a patient has repeated blood loss, the pulse should become sinking and thin; if it remains floating and large, it indicates death.” The so-called “large and firm” refers to the pulse not changing or transforming, rather than a combination of floating and large pulses with firm pulses.
From the records of the classic pulse diagnosis literature regarding the Geng and Ge pulses, if the pulse changes or transforms according to the development rules of the disease, it is a Geng pulse. If it does not undergo corresponding changes or transformations, it is a Ge pulse. This indicates that in clinical practice, examining the changes and transformations in pulse patterns according to the development rules of the disease has very important significance. Moreover, the development of diseases follows certain rules, and changes in pulse patterns must also follow certain rules. If the changes in pulse patterns do not conform to the development rules of the disease, further identification and analysis are necessary. This is very important for clinical differentiation and must not be overlooked.
All of the above indicates that the twenty-six commonly used pulse patterns selected and established by ancient physicians each have specific targeting, and their diagnostic significance is very important. However, due to the burial or misunderstanding of some of the twenty-six pulse patterns, the methods for identifying pulse patterns have been affected, and this has also impacted the analysis of pulse patterns and their main diseases. Therefore, one should master the identification and analysis methods of each pulse pattern based on the normative and practical significance of the twenty-six commonly used pulse patterns, which is the foundation for identifying and analyzing complex pulse patterns.
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