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Chapter 8 of 28
濒湖脉学
Overall Paraphrase
This section discusses the vacuous pulse (referring to a pulse that is weak in force and feels soft and empty when pressed, belonging to the yin category of pulse images). Its typical tactile sensation is: the pulse arrives slowly, the pulse shape is relatively large and soft, there is insufficient force when pressing, and there is a hollow, empty feeling under the fingers. Cui Zhixu summarized it as "large in shape but thin in force"—although the pulse shape is large, the driving force is weak, and this is precisely the manifestation of "vacuity."
The Mai Jue (Pulse Song) says that for the vacuous pulse, "seeking it, it is insufficient; lifting it, it is excessive." Li Shizhen believed that this merely describes the floating pulse (clearly felt with light pressure, insufficient with heavy pressure) and does not capture the characteristic of the vacuous pulse being "soft, empty, and lacking force." Yang Renzhai described it as "resembling willow catkins, scattered and slow," and Master Hua said it is "scattered, large, and soft." These descriptions are more like manifestations of the scattered pulse (pulse qi scattered and without root) and are not the vacuous pulse.
The form-comparison poem further compares: when lifted lightly, the pulse is slow and large; when pressed heavily, it is soft and empty. The pulse boundary is unclear, like an empty valley. Do not confuse it with the hollow pulse (which feels like a hollow scallion tube when pressed)—the hollow pulse is floating, large, and hollow in the center, indicating major blood loss; the vacuous pulse is floating, large, and slow, with no force when pressed, indicating blood vacuity (insufficiency of blood failing to fill the vessels). The floating pulse and scattered pulse belong to another category and must be distinguished separately.
The disease-indication poem says: a vacuous pulse with concurrent body heat often indicates summerheat damage (summerheat consuming qi and injuring fluids); spontaneous sweating, palpitations with anxiety, easy startling, and excessive dreaming are also common. If fever is due to yin vacuity (insufficiency of yin fluids with internally generated vacuous heat), regulate it as early as possible. The classical approach is to nourish the nutritive and boost qi (nourish the nutritive blood and supplement upright qi; this pertains to principle and method, not medication guidance)—do not delay.
When the cubital pulse is vacuous, it suggests blood failing to nourish the heart; when the bar (guan) pulse is vacuous, abdominal distension and postprandial discomfort may be seen; when the chi (cubital, at the Shenmen region) pulse is vacuous, it is often related to bone-steaming, wilting-bi, and damage to essence and blood.
The classics state: when blood is vacuous, the pulse is vacuous; when the pulse qi arrives weak and fine, it belongs to "insufficiency," with the disease located internally; if a vacuous pulse appears in chronic disease, the prognosis is relatively poor.
The core pathogenesis of the vacuous pulse is qi and blood depletion, insufficient filling of the pulse pathway, and qi failing to drive the pulse. Although the pulse shape may be relatively large, "lack of force" is the key to identifying the vacuous pulse. In Chinese medicine pulse diagnosis, there is an emphasis on "distinguishing vacuity and excess by force or lack of force," and this is exactly the key point of differentiation for the vacuous pulse.
Li Shizhen specifically emphasizes pulse differentiation: the floating pulse is "excessive when lifted, insufficient when pressed"; the hollow pulse is hollow like a scallion tube and indicates loss of blood; the scattered pulse is scattered and without root; the vacuous pulse is "slow, large, and soft, with no force when pressed." Although all four pulses fall within the floating-large category, their pathogenesis and indications differ and must not be confused.
Regarding indications, the vacuous pulse can correspond to various deficiency patterns such as summerheat damage, yin vacuity fever, blood failing to nourish the heart, spleen vacuity with abdominal distension, and essence-blood depletion. The core issue is insufficiency of upright qi, yin blood, and essential substances in the human body.
Pulse diagnosis carries a significant degree of subjectivity, and different practitioners may have different tactile judgments of the vacuous pulse. However, descriptions such as "no force when pressed" and "hollow and empty" correspond to a certain degree with states of reduced vascular filling, decreased cardiac output, and low peripheral circulatory resistance in modern medicine.
The Chinese medicine concepts of blood vacuity and yin vacuity cannot be simply equated with modern medicine's anemia, dehydration, or malnutrition. They are comprehensive syndrome concepts. When a vacuous pulse appears in chronic disease, it often suggests that overall circulatory and metabolic status is poor, carrying certain prognostic significance, but it should not be taken as an absolute judgment.
—— Buguā Reminder: This content is based on classical Chinese medicine texts and is provided solely for the study and research of traditional culture. It does not constitute any form of medical diagnosis, medication guidance, or treatment advice. If you feel unwell, please seek medical attention promptly.