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Three fingers determine life and death, pressing the pulse at the wrist to know the ailments. Pulse diagnosis is a unique diagnostic method in TCM, which is indeed miraculous. While it is miraculous, it is also difficult to learn and understand. Even TCM practitioners often feel that while they have a clear understanding in their hearts, it is hard to express through their fingers, making it even more mysterious for the general public.
However, pulse diagnosis in TCM has observable patterns and can be objectively assessed. Let us explore the “slippery pulse” as a specific pulse type.
Pulse diagnosis involves feeling the pulse, commonly using the cun (寸) method, which involves placing three fingers on the radial artery at the wrist to perceive the pulse’s position, quantity, and form, thereby understanding internal bodily changes.
There are twenty-eight common pulse types, and the slippery pulse (滑脉) is one of them.
What is the slippery pulse? In Li Shizhen’s pulse study, “Binhuhuaixue”, the slippery pulse is described as:
“The slippery pulse is like beads rolling, flowing smoothly back and forth.”
“Do not confuse the slippery pulse with similar types; the pulse should be observed in intervals.”
Even with the above poetic description, some may still find it difficult to understand what a slippery pulse is.
According to the “Pulse Classic”: “The slippery pulse flows smoothly back and forth, rolling and turning, like beads responding to the fingers.” In short, the characteristic of this pulse type is its smooth flow, resembling beads rolling, and it feels round and smooth to the touch.
To simplify, the cun pulse is essentially a line where blood flows, either large or small, high or low, but it should be continuous. However, in this case, there are round beads appearing on this continuous line, independent and protruding. This is the distinctly noticeable slippery pulse.
The slippery pulse generally indicates conditions such as excess heat, food stagnation, and phlegm-fluid retention. Additionally, there are two normal situations for the slippery pulse: one is a normal person’s pulse being slippery and harmonious, indicating sufficient qi and blood; the other is the pregnancy pulse, commonly referred to as the joyful pulse. During pregnancy, a slippery pulse may be observed, reflecting a harmonious state of qi and blood.
How can we use the slippery pulse for diagnosis and treatment? Let’s look at a case study.
First visit: January 1, 2017. Patient: Female, 31 years old. Right cun pulse: large, tight, deep, and thin; left cun pulse: slippery (like beads), deep, strong, and slightly tight. Tongue: red with thin white coating at the front, thick white root, and red spots on the edges. The patient gave birth on May 2, 2016, and has not had her period since. Despite being in the cold winter, she is not afraid of the cold. Bowel movements once a day, dry and hard like sheep droppings, previously once every few days, and she used senna leaves as a laxative. Headache in the front part, feeling like wind blowing. Poor sleep, difficulty falling asleep, waking up and unable to sleep again, and difficulty concentrating. Treatment: Modified Tao Ren Cheng Qi Decoction.
Ingredients: 9g Tao Ren (Peach Kernel), 9g Zhi Gan Cao (Honey-fried Licorice), 30g Sheng Di Huang (Rehmannia Root), 10g Da Huang (Rhubarb) (added later), 9g Zhi Zi (Gardenia), 9g Huang Qin (Scutellaria), 8g Bo He (Peppermint) (added later), 9g Dang Gui (Angelica), 15g Bai Shao (White Peony), 15g Chi Shao (Red Peony), 15g Che Qian Cao (Plantago), 9g Chai Hu (Bupleurum), 9g Chuan Xiong (Szechuan Lovage), 5 doses, self-prepared.
Second visit: August 12, 2017. The patient returned due to post-menstrual spotting. It was learned that after taking the previous medicine, all symptoms disappeared, and now sleep is normal, and bowel movements are regular. However, the headache has slightly recurred, occasionally painful at both temples. Both pulses are thin and slightly deep, more so on the right. Tongue: red with thin white coating.
In this case, the patient had three main symptoms: 1. Difficulty with bowel movements, 2. Headache, 3. Poor sleep. The pulse was primarily tight, with a distinctly noticeable slippery pulse. How is it noticeable? It feels like beads sliding under the fingers. It seems as if the cun pulse and the guan pulse are two separate parts. This slippery pulse undoubtedly indicates a condition of excess heat. Therefore, the treatment principle should be to clear heat. What is the source of this heat? How to clear it? The headache and difficulty with bowel movements are at opposite ends, one above and one below, so we clear the upper and promote the lower. The chosen formula was Tao Ren Cheng Qi Decoction, with additional herbs to nourish yin and clear heat. Remarkably, after just 5 doses, all symptoms disappeared. Seven months later, the slippery pulse also vanished, indicating that the condition of excess heat had resolved.
In this case, the slippery pulse was a crucial symptom. Through the slippery pulse, it was diagnosed as a condition of excess heat, thus the treatment principle was to clear heat, leading to effective results.
The slippery pulse, aside from indicating excess heat in this case, also indicates food stagnation, phlegm-fluid retention, and the pregnancy pulse, which are frequently observed in clinical practice. When food stagnation is present, one should resolve food and eliminate stagnation; when phlegm-fluid retention is present, one should transform phlegm and expel fluids, and treatment should be based on differentiation.
Among the twenty-eight pulse types, the slippery pulse is just one. Understanding the slippery pulse allows for a broader understanding of the significance of pulse diagnosis.
Article reproduced from the “Medical Scholar” WeChat public account
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