Library

Old theories stated that the differences in superficial (Fu) and deep (Chen) pulses were merely variations such as superficial-large and deep-small, superficial-small and deep-large, superficial-slippery (Hua) and deep-choppy (Se), or superficial-choppy and deep-slippery, etc. There was no observation of changes occurring midway through the pulse's rising and falling phases. In recent clinical practice, I have observed two types of pulses. The first type: initially, the qi rises from the deep level to the middle level, being slippery and vigorous with momentum; however, upon reaching the middle level, it suddenly becomes weak and powerless, rising slowly to the superficial level, resembling muddy sludge. Upon its return, it descends slowly from the superficial level to the middle, and then from the middle to the deep level, where it again becomes slippery and vigorous. Whether lightly or heavily pressed, the sensation under the fingers remains consistent. The corresponding symptoms include bodily fatigue, constant drowsiness, a state between sleep and wakefulness, mental palpitations and apprehension, aversion to human voices, photophobia, slight facial heat, slightly cold limbs, lack of appetite without thirst for food but excessive thirst requiring continuous drinking. This indicates dampness in the Wei (Defensive) level, heat in the Ying (Nutritive) level, wind-dryness affecting the Lung, and phlegm-heat in the Stomach. It arises from latent dampness in the body combined with the inhalation of new, excessively dry pathogenic factors. Treatment employs Fangfeng (Saposhnikoviae Radix) and Bencao (Ligustici Rhizoma et Radix) to unblock Wei Yang and expel exterior dampness; Ziwan (Asteris Radix), Baiwei (Anemarrhenae Rhizoma), Xingren (Armeniacae Semen Amarum), and Gualoupi (Trichosanthis Pericarpium) to vent turbid qi in the Lungs; Jiao Shanzha (Crataegi Fructus Carbonized), Zhuru (Bambusae Caulis in Taenia), Shigao (Gypsum Fibrosum), and Hilewangzi (Margarita) to descend and purge phlegm-heat in the Stomach; accompanied by Baishao (Paeoniae Radix Alba) to clear the Liver, and Tianzhuhuang (Calami Tuber) to clear the Heart, thereby restoring mental clarity, physical health, and appetite.

The second type of pulse is exactly the opposite. Initially, rising from the deep to the middle level, it is choppy and weak; rising from the middle to the superficial level, it is restless and rapid, like jumping. Upon return, it descends rapidly from the superficial to the middle, and then slows down to become slow, weak, and devoid of momentum when sinking from the middle to the deep level. Whether lightly or heavily pressed, the sensation remains consistent. Such individuals are addicted to opium, have poor dietary strength, and suffer from impotence. This indicates no pathology in the exterior levels, but phlegm-fluid retention internally, along with deficiency-heat above and deficiency-cold below. Treatment should focus on dispersing the Middle Jiao and warming the Lower Jiao. These two pulse types are not mentioned in ancient texts. Could it be that ancients never saw them? Perhaps they saw them but lacked the words to describe them accurately, simply dismissing them as superficial-slippery, deep-choppy, superficial-rapid, or deep-slow. They failed to realize that within the superficial-deep distinction, slow and rapid cannot coexist, nor can slippery and choppy be identical; these differ significantly from the mid-phase variations described above. Therefore, when writing medical cases, one must not hesitate to repeatedly and meticulously depict complex pulse and symptom patterns to enlighten future students.