Characteristics of the Slippery PulseToday we will learn about the abnormal pulse types—the slippery pulse.1. Characteristics of the Slippery Pulse:The pulse is exceptionally smooth, with a fluidity that exceeds that of a normal pulse, flowing swiftly beneath the fingers. Many pregnant women exhibit a slippery pulse around the third to fourth month of pregnancy, and by the fifth to sixth month, the pulse may feel quite pronounced under the fingers.The sensation of the slippery pulse is such that the time difference between feeling the pulse beat from the ring finger to the index finger is very short.The pulsation of the slippery pulse is characterized by a smooth, continuous flow, reminiscent of a round bead rolling under the fingers; it also resembles the flow of water, always moving forward.2. Mechanisms and Diagnostic Significance of the Slippery Pulse:There are four main mechanisms that lead to a slippery pulse:—Heat invading the Qi level, predominantly in the Yangming channel:Heat invading the Qi level causes a rapid and urgent pulse. If the pulse rate does not significantly increase, it may still result in a very smooth blood flow, indicating an abnormal fluidity. This reflects a rapid blood flow rather than a quickened pulse rate. Since the Yangming channel is rich in Qi and blood, any heat in this area significantly affects the blood and promotes smooth blood flow.Clinical examples of slippery pulse due to heat invading the Qi level are abundant in classical texts. For instance, in the “Shang Han Lun” (Treatise on Cold Damage), it states: “If the pulse is slippery and there is a feeling of cold, there is heat in the interior; Bai Hu Tang (White Tiger Decoction) is indicated.”In another case: “In Yangming disease, if there is delirium, tidal fever, and a slippery and rapid pulse, Xiao Chengqi Tang (Minor Order the Qi Decoction) is indicated.”—Phlegm:Patients with significant phlegm often present with a slippery pulse, especially those with wind-phlegm. For example, a patient with shoulder periarthritis may have a history of several years, and upon palpation, the pulse is slippery, indicating phlegm obstructing the meridians, necessitating phlegm-dispelling treatment. It is essential to differentiate whether the condition is due to wind-dampness or phlegm obstruction, as a slippery pulse indicates phlegm obstruction, while wind-dampness obstruction typically presents with a less smooth pulse or even a choppy pulse. Without the ability to palpate the pulse, accurate diagnosis is challenging.Additionally, if phlegm obstructs the hand’s pericardium channel, the patient may experience dizziness, and the pulse will also be slippery.The primary formula for treating phlegm obstruction in the meridians is Zhi Mei Fu Ling Wan (Polyporus Decoction), and for those with Yang deficiency, Yang He Tang (Yang Harmony Decoction) can be used, with an emphasis on Bai Jie Zi (White Mustard Seed).—Pregnancy:Pregnant women often exhibit a slippery pulse, but it is not a definitive sign that all pregnant women will have a slippery pulse; it is simply more common. The pulse during pregnancy is typically a normal pulse, soft and gentle. Most healthy individuals will also have a slippery pulse. The slippery pulse in pregnant women reflects the body’s accumulation of blood to nourish the fetus.—Food Stagnation:Food stagnation leading to heat is a primary cause of a slippery pulse, primarily due to food accumulation rather than heat. When food stagnation leads to heat, the pulse becomes slippery.—Normal Individuals: Healthy individuals may exhibit a slightly slippery pulse. A slightly slippery and gentle pulse in a healthy person indicates a harmonious balance of Ying and Wei (nutritive and defensive Qi) and abundant Qi and blood.3. Differentiation of Diagnostic Significance of the Slippery Pulse:1. Slippery pulse caused by excess pathogenic factors is characterized by a slippery and forceful pulse, often accompanied by a rapid pulse or a rapid pulse indicating heat in the Qi level; if it is floating, it may indicate wind-phlegm in the lungs; if it is deep, it may indicate phlegm-heat in the interior; if it is slow or wiry, it may indicate cold-phlegm.2. The slippery pulse during pregnancy is soft and gentle.3. A normal person’s pulse is slightly slippery and gentle.4. Main Diseases Associated with the Slippery Pulse (Plain Language Explanation of Pulse Studies):The slippery pulse is primarily associated with phlegm or food injury; it indicates blood accumulation below and vomiting above;(The slippery pulse is a manifestation of internal pathogenic factors. Conditions such as phlegm retention, food stagnation, blood stasis, and Qi stagnation can all present with a slippery pulse. Phlegm retention often presents as floating and slippery, food stagnation as deep and slippery, and blood stasis as a slippery pulse often found in the Guan position, while vomiting is associated with a slippery pulse in the Cun position.)5. Poem on the Slippery Pulse (Plain Language Explanation of Pulse Studies):Body Type Poem:The slippery pulse rolls like a bead, flowing smoothly back and forth; do not confuse the slippery pulse with the rapid pulse, as the rapid pulse is characterized by an increase in frequency.(The slippery pulse resembles a round bead, continuously and smoothly pulsating. Clinically, one should not confuse the slippery pulse with the rapid pulse, as the rapid pulse indicates an increase in frequency, while the slippery pulse is merely characterized by smoothness.)Main Disease Poem:The slippery pulse indicates declining Yang Qi, phlegm causes numerous diseases, food leads to disasters; above it indicates vomiting, below it indicates blood accumulation; for women, a regulated pulse often indicates pregnancy.(The slippery pulse is typically a sign of excess Yang Qi but can also indicate declining Yuan Qi, unable to contain the fire of the liver and kidneys, leading to heat in the blood and a slippery pulse. Internal phlegm, wind-phlegm obstruction, food stagnation, and various pathological changes can lead to vomiting or blood stasis, often presenting with a slippery pulse. However, a slippery pulse in women without disease often indicates pregnancy.)Segment Poem:Cun slippery indicates phlegm causing vomiting, sour regurgitation, stiff tongue, or cough; Guan slippery indicates food stagnation with liver and spleen heat, thirst, diarrhea, or dysuria; Chi slippery indicates damp-heat in the kidneys or bladder, leading to thirst, dysentery, or urinary issues.(Phlegm retention in the chest can lead to vomiting, sour regurgitation, stiff tongue, and cough, often presenting with a slippery pulse in the Cun position. Liver heat and spleen stagnation due to food stagnation often present with a slippery pulse in the Guan position. Damp-heat in the kidneys or bladder can lead to thirst, dysentery, or urinary issues, often presenting with a slippery pulse in the Chi position.)6. Conclusion:When examining the slippery pulse, in addition to its characteristic of being “like a round bead,” the pulsation is often forceful, generally indicating abundant Yang Qi with slight heat. However, the “main disease” section states, “the slippery pulse indicates declining Yang Qi,” which seems contradictory. Apart from the possibility of Qi deficiency failing to contain the fire of the liver and kidneys, leading to a slippery pulse due to blood heat, it is unlikely for individuals with declining Yuan Qi to exhibit a slippery pulse.——————END——————*This article is excerpted from “Sixteen Lectures on Clinical Pulse Studies”; for further study, please refer to the original text.
