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Chapter 4 of 28
濒湖脉学
Overall Paraphrase
The opening of "Binhu Maixue · Chi (Slow Pulse)" states: The slow pulse (chi mai) belongs to yin. Its basic characteristic is "three beats per breath" — within one complete respiratory cycle, the pulse beats only three times, with both the arrival and departure of the pulse being extremely slow. This description originates from the Maijing (Pulse Canon).
Its underlying mechanism is "yang failing to overcome yin": when yang qi (the body's warming and propulsive force) cannot prevail over yin cold, the pulse "cannot keep up," as if failing to match the normal rhythm.
Li Shizhen then corrects an error in the Maijue (Pulse Rhymes): the Maijue states that the slow pulse is only felt with heavy pressure, visible at the deep position but not the superficial, and that the pulse is faint and indistinct in shape. Li Shizhen considers these to be features not of the slow pulse but of the choppy pulse (se mai), and that this error is obvious.
The Physical Description Verse states: The slow pulse has only three beats per breath, and the pathological mechanism is yang failing to overcome yin, with qi and blood偏向 cold. Clinically, floating or sinking (depth of pulse position) can be used to differentiate exterior from interior: floating-slow tends toward exterior cold, while sinking-slow tends toward interior cold. In terms of treatment approach, eliminating yin cold fundamentally lies in warming and supplementing the source of yang qi — that is, "benefiting the source of fire to dispel yin shadows." This is an ancient principle of treatment, not specific medication advice.
The Comparative Verse states: Three beats per breath is called slow; slightly faster than slow is called moderate (huan mai); slow with a thin pulse shape and rough, impeded movement suggests the choppy pulse; floating, slow, and large pulses should be considered from the perspective of deficiency. Following this, there is additional differentiation: slow with force or without force, and other distinctions should be made by combining pulse shape and rhythm. Among these, "floating-large and playful (shua) indicate deficiency" — the character "耍 (shua)" is suspected to be an error for "软/濡 (soft/soggy)", and the standard editions mostly read "floating-large and soft indicate deficiency." The phrase "with force is moderate" in the original text also has textual variants across editions, which requires attention in study.
Master Li's (Li Shi) differentiation states: The slow pulse tends to be thin, small, and replete; the moderate pulse tends to be large and slow. The slow pulse mostly indicates excessive yin and debilitated yang, while the moderate pulse mostly indicates exuberant defensive qi and weakened nutritive qi — the two should be distinguished.
The Indications Verse states: In Chinese medicine, the radial artery pulsation at the wrist is divided into three sections — cun, guan, and chi — each corresponding to different body regions. The slow pulse mostly indicates organ disease, and can also be seen in phlegm-rheum, chronic stubborn illness, and zhengjia (abdominal masses, either palpable or aggregating and dispersing), requiring careful differentiation. Slow with force often indicates cold pain due to cold-pathogen stagnation; slow without force mostly indicates deficiency cold. By section: Cun-position slowness mostly suggests cold in the upper jiao (above the chest and diaphragm); Guan-position slowness mostly suggests cold pain in the middle jiao (spleen, stomach, and abdomen); Chi-position slowness mostly suggests kidney deficiency, possibly with heavy lower back and legs, urinary and fecal incontinence, and hernia involving the testicles. In summary: the slow pulse indicates organ disease — forceful slow is mostly cold pain, unforceful slow is mostly deficiency cold, floating-slow is exterior cold, and sinking-slow is interior cold.
All of the above represents the pulse-diagnosis experience of the ancients and should be evaluated comprehensively with the four diagnostic methods; one cannot diagnose disease based solely on pulse signs.
The core of the slow pulse lies not in "slowness" itself, but in the yin-yang relationship behind the slowness. The ancients believed that pulse propulsion depends on yang qi. The appearance of a slow pulse indicates insufficient driving force of yang qi, with yin cold relatively predominant, hence the slowed pulse.
Li Shizhen particularly emphasizes two points:
First, the slow pulse cannot be determined solely by "slowness." It must be differentiated by combining floating/sinking, force/weakness, pulse body size, and rhythm regularity. For example: floating-slow tends toward exterior cold; sinking-slow tends toward interior cold; forceful tends toward cold-excess with cold pain; unforceful tends toward deficiency cold. This approach of "one pulse, multiple meanings; four-diagnosis synthesis" is the essence of Chinese medical pulse diagnosis.
Second, the slow pulse must be differentiated from moderate, choppy, knotted, and deficient pulses. The moderate pulse is slightly faster than slow, with relaxed coming and going; the choppy pulse has impeded, rough movement with a thinner shape; the knotted pulse has irregular pauses within a slow rhythm; extreme slowness can develop into a failing pulse. Li Shizhen also corrected the error of the Maijue attributing choppy pulse characteristics to the slow pulse, reflecting an attitude of combining philological textual research with clinical practical evidence.
"To dispel yin, one must benefit the source of fire" reflects the Chinese medical approach to treating cold conditions: rather than simply attacking and expelling yin cold, one begins with warming and supplementing the fundamental source of yang qi. This belongs to the academic thought at the level of treatment principles.
From a modern physiological perspective, the slow pulse broadly corresponds to a relatively slow resting heart rate. The ancients defined "three beats per breath" as slow; roughly estimating with an adult respiratory rate, this would correspond to a heart rate of around 40–50 beats per minute, but this is only a very rough reference and cannot be mechanically converted.
In modern medicine, a slow resting heart rate can be physiological, such as in long-term athletes or during sleep; or pathological, such as in hypothyroidism, conduction system abnormalities, increased intracranial pressure, or the effects of certain medications. The Chinese medical statement that "slowness indicates cold" has some observational basis in that heart rate slows in cold environments or when metabolism is low and heat production is insufficient, but not all slow heart rates belong to cold patterns.
It is worth noting that the ancients used the physician's own breath as the timing unit, which was significantly influenced by the physician's respiratory rate and lacked standardization. Modern pulse-taking can be combined with objective examinations such as heart rate and ECG. The value of Chinese medical pulse diagnosis lies in assessing the body's state through comprehensive information including pulse position, force, momentum, and rhythm, rather than diagnosing disease solely by pulse rate.
From the perspective of "slowness indicates cold; yang failing to overcome yin," general daily care may include:
If one notices a significantly slow pulse accompanied by pronounced cold intolerance, fatigue, dizziness, or episodes of blacking out, one should seek medical attention promptly rather than self-diagnosing as "cold pattern" or self-administering warming supplements.
Related Concepts: Rapid pulse (shuo mai) (five to six or more beats per breath, mostly indicating heat), moderate pulse (huan mai) (four beats per breath, relaxed coming and going), choppy pulse (se mai) (impeded, rough movement), knotted pulse (jie mai) (slow rhythm with irregular pauses), floating/sinking (depth of pulse position), exterior/interior, cold/heat, deficiency/excess (the eight-principle differentiation), defensive/nutritive qi and blood (levels of qi and blood in the body).
Further Reading: Binhu Maixue·Shuo (Rapid Pulse), Binhu Maixue·Huan (Moderate Pulse), Binhu Maixue·Se (Choppy Pulse), Binhu Maixue·Jie (Knotted Pulse); Maijing (Pulse Canon), Book 1, "Slow Pulse"; Suwen · Pingren Qixiang Lun on pulse rate and normal pulse; Wang Bing's commentary on Suwen regarding the treatment principle of "benefiting the source of fire to dispel yin shadows."
BuGua's Reminder: This content is based on classic Chinese medical texts and is provided solely for traditional culture study and reading. It does not constitute any medical diagnosis, medication, or treatment advice. Please seek medical attention promptly if you feel unwell.