Abnormal Pulse Types: String PulseToday we will learn about the abnormal pulse types—the String Pulse.1. Characteristics of the String Pulse:When the pulse beats, it feels like pressing a taut string, where the pulse’s rise should be firm and straight, resembling a string. It moves directly up and down, tightly stretched.Clinically, the tightness of the String Pulse varies with the condition, and thus the degree of the String Pulse can be classified as:String Pulse → Slightly String Pulse → Mild String Pulse → Weak String Pulse.2. Mechanism of Formation and Diagnostic Significance of the String Pulse:1. Liver and Gallbladder Qi Stagnation:The Liver and Gallbladder are responsible for the smooth flow of Qi. If Qi is not flowing smoothly, it becomes stagnant, leading to a String Pulse.2. Wind Force (mainly referring to Liver Wind, including Yin Deficiency leading to Liver Wind movement):This Wind primarily refers to internal Wind, not external Wind. The sensation under the fingers when feeling the String Pulse is similar to that of a rope; Liver Wind can cause a String Pulse. If a person has abundant Yang Qi, which is hyperactive, excess Yang can generate Wind, resulting in a hard String Pulse.Additionally, Yin Deficiency can also cause Liver Wind movement, leading to a String Pulse, which is often thin, slow, and tense, and is relatively common in clinical practice.3. Fluid Stagnation Blocking Qi Mechanism:The concept of the San Jiao (Triple Burner): The San Jiao should be considered a tangible organ, essentially a large membrane spread throughout the thoracic and abdominal cavities (including pleura, peritoneum, diaphragm, etc.); all organs are situated within its upper, middle, and lower regions, protected by it. Its main function is to regulate water. It is also the fire organ of the Kidney, responsible for the circulation of Qi, blood, and body fluids. Therefore, its pathological changes are mostly due to fluid accumulation, leading to swelling, with a minority being due to Qi stagnation (Qi aspect) and blood stasis (blood aspect). However, Qi stagnation can prevent fluid movement, and blood stagnation is closely related to “fluid accumulation.” Although the onset may emphasize the upper, middle, or lower regions, they are interrelated, often affecting the entire San Jiao. The source of the disease often comes from the organs located in different areas, but there are still characteristics of membrane lesions present in common symptoms.Fluid pathogens stagnate in the membrane, obstructing the flow of Liver and Gallbladder Qi, leading to Qi stagnation, which can result in a tense and String Pulse.4. Cold or Dampness Blocking Qi Mechanism:String Pulses caused by Cold or Dampness are relatively rare. Clinically, Cold can also lead to a String Pulse, but it is not tight. Zhang Zhongjing stated: “A double String Pulse indicates Cold… a slightly String Pulse indicates fluid.” This is mainly due to Cold remaining in the meridians, causing Qi and blood to contract, leading to a String Pulse.In clinical practice, patients with abdominal pain, tightness and pain in the flanks, and cold hernia often exhibit a String Pulse. Qi blockage leads to pain, etc. For example, in the “Jin Gui Yao Lue: Abdominal Fullness, Cold Hernia, and Food Stagnation” chapter: “A String Pulse at the wrist indicates tightness and pain in the flanks, and the person feels cold.”Dampness (Phlegm) can also cause stagnation of Qi, as Dampness (Phlegm) tends to accumulate and easily obstruct Qi. If the Dampness (Phlegm) is particularly stubborn, it can also lead to a String Pulse.3. Differentiation of Diagnostic Significance of the String Pulse:Distinguishing the String Pulse can be challenging and requires a combination of the four examinations, but it can sometimes provide a basis for differentiation.1. Liver and Gallbladder Qi Stagnation often presents with a String Pulse on the left side, or even a prominent left pulse.Liver and Gallbladder Qi Stagnation is often a single hand String Pulse, predominantly on the left side, rarely on the right side; most are left-sided String Pulses, and bilateral String Pulses are less common. Some patients may only have a prominent left pulse, resembling a bean inside.2. Wind-induced String Pulses often present with all six pulses being String.String Pulses caused by Wind often show all six pulses as String, and are commonly seen as floating String on both hands, indicating chaotic Qi and blood. String Pulses caused by external Wind are also less common; Liver Wind attacking upward, dizziness and headache are the primary symptoms, and the appearance of these symptoms is significant for diagnosis. If the String Pulse is severe, the headache is characterized by distension, throbbing, and pressure at the top of the head, with pain that comes in waves.3. Fluid and Dampness-induced String Pulses are often String and Rough.If the String Pulse is caused by fluid and Dampness obstructing Qi, it tends to be String and Rough, as fluid often presents with a Rough pulse. Dampness can also lead to a non-smooth pulse, so it often presents as String and Rough.4. Cold-induced String Pulses can be tight.4. Main Diseases Associated with the String Pulse (Plain Language Explanation of Pulse Theory):The String Pulse is associated with fluid, primarily related to the Liver and Gallbladder; a rapid String Pulse indicates heat, while a slow String Pulse indicates cold; floating String indicates fluid, while sinking String indicates pain; Yang String indicates headache, while Yin String indicates abdominal pain.(Fluid: a type of phlegm-fluid disease characterized by symptoms such as cough, shortness of breath, chest fullness, accompanied by mild edema, and dark skin.)(Suspended Fluid: due to fluid retention in the chest, symptoms include cough, flank pain, and occasional vomiting.)(The String Pulse is commonly seen in fluid-related diseases, especially in conditions of the Gallbladder and Liver. A rapid String Pulse often indicates excess heat; a slow String Pulse often indicates excess cold. A floating String Pulse is often associated with fluid, while a sinking String Pulse is often associated with suspended fluid causing flank pain. Headaches are often seen with a String Pulse at the wrist, known as Yang String; abdominal pain is often seen with a String Pulse at the ankle, known as Yin String.)5. Poems about the String Pulse (Plain Language Explanation of Pulse Theory):Body Condition Poem:The String Pulse is long and straight, the Liver channel is strong, and the Earth is harmed; anger fills the chest, often wanting to shout, tears flow like rain.(The appearance of the String Pulse under the fingers gives a feeling of length and straightness. The String Pulse is primarily due to excessive Liver Qi. The hyperactive Liver Qi continuously rises, inevitably affecting the digestion of the Spleen and Stomach. Liver Qi stagnation easily causes chest and flank fullness, leading to emotional unrest, with a constant urge to shout for relief. If the Liver Qi continues to rise, transforming into Wind-Heat, symptoms such as blurred vision and tearing may occur.)Similar Poems:The String comes straight like a silk string, tight as a rope, bouncing left and right; tightness indicates strength, String indicates form, the long pulse is firm and hidden.(The characteristic of the String Pulse is its length and straightness, resembling the feel of a string on a musical instrument. The String Pulse differs significantly from the Tight Pulse and the Firm Pulse. For example, while both the String Pulse and Tight Pulse exhibit tension, the Tight Pulse is as tight as a twisted rope and strong, while the String Pulse is merely tense with a straight appearance; the String Pulse and Firm Pulse both exhibit length, but the Firm Pulse only appears in a sinking state, while the String Pulse does not necessarily appear in a sinking state.)Main Disease Poem:The String Pulse of the Liver and Gallbladder divides Yin and Yang, fluid, phlegm, cold, and heat entangle the body; floating and sinking, slow and rapid must be distinguished, large and small have weight and light.(When the Liver and Gallbladder are affected, the pulse often presents as String. Whether the disease is due to Yang or Yin pathogens, a String Pulse can be observed. However, Yang pathogens often present as large and slippery String Pulses, while Yin pathogens often present as tight and thin String Pulses. For example, fluid conditions, phlegm conditions, alternating cold and heat, and malaria often show a String Pulse, but careful differentiation is needed between floating, sinking, slow, and rapid. For instance: suspended fluid (symptoms include cough, shortness of breath, and edema) presents as floating String, while retained fluid (symptoms include cough, flank pain, and water retention) often presents as sinking String; excess heat presents as rapid String, while excess cold presents as slow String; deficiency conditions often present as large String, while tightness (hands and feet cramping and unable to flex) often presents as small String; fluid accumulation (symptoms include clear watery sputum, abdominal masses, acid regurgitation, and flank pain) often presents as a single hand String, while cold retention (symptoms include abdominal pain, diarrhea, cold rising, cold hands and feet, and hernia pain) often presents as bilateral String; a mild disease often presents as a soft String, while a severe disease often presents as a hard String.)Divisional Poem:String at the wrist indicates headache and phlegm in the diaphragm, alternating cold and heat indicates left flank; right flank pain indicates cold in the stomach and chest, String at the ankle indicates Yin hernia and foot cramping.(For phlegm stagnation in the chest and headaches, the pulse at the wrist often presents as String. Alternating cold and heat, and conditions like masses often relate to Liver and Gallbladder issues, with the left flank pulse showing String; if Cold is prevalent in the Spleen and Stomach, abdominal pain often presents with a String pulse on the right flank. For Yin hernia (testicular pain radiating to the lower abdomen), cramping in the feet is often associated with Liver and Kidney deficiency cold, with the String pulse often seen at both ankles.)6. Conclusion:The pulse that is long, straight, and has significant tension is termed the “String Pulse.” It is commonly seen in liver diseases, pain conditions, and fluid conditions, and is one of the most frequently observed pulse types in clinical practice, often resulting from a mixture of cold and heat pathogens, especially prevalent in cold conditions.——————END——————*This article is excerpted from “Sixteen Lectures on Clinical Pulse Theory.” For further study, please refer to the original text.
