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Chapter 20 of 28
濒湖脉学
The thin pulse is yin in nature. Its presentation: even finer than the faint pulse, yet always palpable beneath the fingers; the pulse thread is thin and straight, soft in texture, like a silk thread gently touching the fingertip. This is recorded in the Maijing (Pulse Classic). The Suwen (Plain Questions) refers to the thin pulse as the "small pulse." Wang Bing compares it to shepherd's purse, describing its soft and slender quality. The Maijue (Pulse Song) states that the thin pulse "comes and goes extremely faintly," which erroneously makes the faint pulse sound larger than the thin pulse—contradicting the classics.
Verse on Form says: The thin pulse comes continuously, fine as a silk thread; upon deep palpation, it still responds to the fingers, endless and unbroken. In spring and summer seasons, or in young people, a thin pulse is generally unfavorable; in autumn and winter, or in the elderly and frail, a thin pulse actually accords with the season and constitution.
Verse on Differentiation advises: See also the faint pulse and the soft pulse.
Verse on Indications says: A thin pulse winding around the fingers mainly indicates depletion of blood and qi, various deficiency-consumption and overwork injuries, and imbalance of the seven emotions (joy, anger, worry, thought, grief, fear, surprise); if not due to dampness invading the lower back and kidneys, then it results from yang qi and essence leaking out with sweating.
At the inch position, a thin pulse commonly indicates frequent vomiting; at the bar position, it mainly indicates abdominal distension and stomach deficiency; at the cubit position, it mainly indicates cold in the dantian (the region where primordial qi accumulates in the lower abdomen), with manifestations of diarrhea, dysentery, and seminal emission—what the ancients called "yin depletion" (severe exhaustion of yin fluids).
The Maijing says: A thin pulse indicates scant blood and weakened qi. If there are corresponding deficiency manifestations, the pulse matches the condition, which is favorable; if there are no such deficiency manifestations, it is contrary and unfavorable. Therefore, when persons with hematemesis or epistaxis present a deep thin pulse, it indicates that pathogenic heat is not excessive, and the prognosis is relatively good; in those suffering from anxiety and overwork, the pulse also tends to be thin.
The essence of the thin pulse is qi and blood failing to fill the pulse channel. With scant blood and weakened qi, the vessel is not replete, hence the thin pulse form; yet because qi and blood still circulate, it remains fine yet continuous under the fingers, like a silk thread responding. Li Shizhen particularly emphasizes the distinction between the thin pulse and the faint pulse: the thin pulse, though fine, is clearly discernible, whereas the faint pulse is weak and blurred, seeming present yet absent. This differentiation reflects the refined grasp of "degrees of deficiency" in Chinese pulse diagnosis.
The text also embodies an important principle: correlating pulse with syndrome. A thin pulse indicates deficiency; if the patient genuinely has deficiency-consumption and overwork injuries, then pulse and syndrome correspond, which is favorable; if pathogenic excess is present yet a thin pulse appears instead, it suggests that proper qi is too depleted to resist pathogens, which is unfavorable. This reflects that Chinese medicine does not view the pulse in isolation but interprets it within the overall pathological mechanism.
The "narrow pulse vessel, clearly palpable but not forceful" described by the thin pulse bears some resemblance to conditions in modern palpation that may involve decreased vascular filling, reduced effective circulating blood volume, peripheral vasoconstriction, or weakened cardiac pump function. However, the Chinese medical "thin pulse" is part of a holistic syndrome and cannot be directly equated with any single modern disease. Li Shizhen's discrimination between thin and faint pulse sizes represents an antique academic viewpoint; different physicians held differing views, and one need not hold it to modern instrumental standards.
A thin pulse suggests relative deficiency of qi and blood. In daily life, one should avoid excessive consumption: refrain from chronic sleep deprivation, excessive rumination, and emotional suppression; eat moderately, and avoid extreme dieting or excessive sweating from overexertion. In autumn and winter, one may align with the governing spirit of storing and reining in; the elderly and frail should pay particular attention to restorative care. If long-term fatigue, emaciation, or a lusterless complexion occurs, seek medical attention promptly rather than self-diagnosing solely by pulse.
The hidden pulse is yin in nature. The hidden pulse requires pressing heavily all the way down to the bone before a slight pulsation is felt beneath the fingers. The Maijing states that the pulse travels beneath the sinews. The Kanwu says the same. The Maijue describes the hidden pulse as "sought and it seems present, with breath held it disappears completely," which Li Shizhen considers a grossly erroneous description.
Verse on Form says: To find the hidden pulse, one must push aside flesh and sinews, pressing down to the bone in search; only then does the finger feel a faint throbbing—its position is extremely deep. The hidden pulse may appear in febrile disease before sweating, when yang qi is about to resolve outward; it may also appear in yin patterns such as cold limbs and abdominal pain around the navel.
Verse on Differentiation advises: See also the deep pulse.
Verse on Indications says: The hidden pulse indicates cholera with frequent vomiting; abdominal pain often due to retained food; water retention and congealed phlegm forming accumulations; the ancients held the treatment principle should be to dispel cold and warm the interior, without delay. (This is a discussion of classical theory; not a medication guide.) When food stagnation is congested in the chest, both inch pulses are hidden, with an urge to vomit that cannot be expressed and constant nausea; at the bar position, a hidden pulse indicates abdominal pain and heaviness; behind the bar, a hidden pulse indicates severe hernia pain.
In febrile disease, a hidden pulse on one hand alone is called single hidden, and on both hands, double hidden. One must not mistake a yin pattern simply because yang-pattern febrile disease presents a hidden pulse. This is a case of fire pathogenic heat constrained internally, unable to diffuse outward—extreme yang resembling yin—hence the hidden pulse, which must resolve through profuse sweating. It is like before a long drought brings rain: heaven and earth are overcast on all sides, and after the rain, all things revive. There is also a type of cold-wound with lurking yin (jia-yin cold damage), in which latent yin exists internally first, and external cold is then contracted; yin prevails and yang declines, with cold extremities and all six pulses deep and hidden. The ancients held that dried ginger and aconite-type warming medicinals should be used, along with moxibustion at Guanyuan point, before the pulse would reappear. If both the Taixi and Chongyang pulses cannot be felt, the ancients considered the prognosis extremely poor. (The above are classical records for scholarly study only, not medication guidance.)
The Maijue contains the saying "slowly inducing sweat will bring safety," and some ancients treated with Mahuang Fuzi Xixin Tang; Li Shizhen regards all of these as incorrect. Liu Yuanbin says: The hidden pulse should not be treated by inducing sweat.
The hidden pulse is even deeper than the deep pulse, requiring one to push aside sinews and press to the bone before it can be perceived. Its core pathology involves deeply lurking pathogenic qi or constraint of yang qi. The text distinguishes two opposite scenarios: first, yīn cold rampant internally with yang qi debilitated, such as cholera, retained food, accumulations, and cold-damage with lurking yin; second, fire heat constrained internally, extreme yang resembling yin, such as before sweating in febrile disease, when yang heat cannot reach the exterior and instead manifests as a hidden pulse. Therefore, one must not determine cold pattern upon seeing a hidden pulse without comprehensive pulse-syndrome correlation.
The text also raises an important contraindication: the hidden pulse should not be treated by inducing sweat. Because the hidden pulse mostly indicates pathogenic qi lurking internally or yang qi constrained, inducing sweat may aggravate the constraint or damage proper qi. This reflects the ancients' cautious approach to the pathology of the hidden pulse.
The hidden pulse describes an extremely deep pulse that can only be appreciated with heavy pressure. In modern palpation, markedly diminished superficial arterial pulsation may be associated with reduced effective circulating blood volume, altered peripheral vascular resistance, or weakened cardiac pump function, but the hidden pulse should not simply be equated with shock or hypotension. The traditional discussion of "extreme yang resembling yin" reflects the ancients' recognition of complex pathological states but carries the limitations of its era. The statement "death is certain if pulse is absent at both Taixi and Chongyang" was an ancient judgment of critical illness; modern practice should integrate vital signs, imaging, and laboratory findings rather than prognosticate according to antique standards.
The conditions indicated by the hidden pulse are mostly acute, severe, or deeply lurking patterns not suitable for ordinary readers to self-diagnose. In daily life, one may practice dietary moderation, avoiding binge eating, excessive uncooked and cold foods, and keeping warm to prevent invasion by cold pathogens. If acute symptoms such as severe abdominal pain, frequent vomiting, or cold extremities occur, seek emergency medical care immediately; do not self-medicate or wait.
The stirring pulse is yang in nature. The stirring pulse belongs to the rapid pulse category, appearing at the region just above and below the bar position; it has no head or tail, shaped like a soybean, with pronounced pulsation that is shaking and unrestrained.
Zhang Zhongjing says: When yin and yang qi contend with each other, it is called a stirring pulse. A stirring pulse in the yang region indicates sweating; in the yin region, fever. If the body feels cold and one fears cold, this indicates injury to the triple burner. Cheng Wuji says: When yin and yang contend, the weaker side stirs; thus, with yang deficiency, a stirring pulse appears in the yang region, and with yin deficiency, in the yin region. Pang Anchang says: The three fen before the bar constitute the yang region, the three fen after the bar constitute the yin region, and the bar itself is half yin and half yang; hence the stirring pulse appears where the deficiency lies.
The Maijue describes the stirring pulse as "sought and it seems present, lifted and it is gone, remaining in one place, neither coming nor going, sinking through all three regions," which Li Shizhen considers vague and absurd—not at all the stirring pulse. Zhan Shi describes the stirring pulse as bulging like a hook or floating like hair, which is even more mistaken.
Verse on Form says: The stirring pulse at the bar position stirs and shakes with rapidity, having no head and no tail, round like a bean; its essence is yin and yang contending, where the deficient side stirs and the dominant side remains quiet.
Verse on Indications says: The stirring pulse indicates pain and fright; stirring in the yang region indicates sweating, and in the yin region, fever; it may also indicate diarrhea, dysentery, and cramping; in men, seminal loss, and in women, uterine bleeding.
Zhang Zhongjing says: The stirring pulse indicates pain and fright. The Suwen says: Yin blood depleted and yang qi striking is termed uterine bleeding. It also says: When the pulse at the Hand Shaoyin of a woman stirs markedly, it is a sign of pregnancy.
The essence of the stirring pulse is localized contention between yin and yang qi, with the deficient side stirring. It characteristically appears at the bar region, headless and tailless, bean-sized, with brief, tremulous pulsation. The ancients believed that pain, fright, sweating, fever, diarrhea, dysentery, cramping, seminal loss, and uterine bleeding could all arise from yin-yang constriction manifesting as a stirring pulse. This is because pain and fright disturb the dynamics of qi, provoking yin-yang conflicts; constitutionally deficient individuals are also prone to localized yin-yang fighting.
The text also mentions "when the pulse at the Hand Shaoyin of a woman stirs markedly, she is pregnant"—an empirical observation in traditional pulse diagnosis and a component of classical diagnostic methodology, though not equivalent to a modern definitive determination.
The stirring pulse's description of "at the bar, bean-sized, headless and tailless, shaking" may correspond in palpation to a locally pronounced pulsation related to local vascular tension, blood flow impact, emotional stress, or painful stimulation. Modern medicine does not determine pregnancy through pulse palpation; the notion that marked stirring at the Hand Shaoyin indicates pregnancy is an empirical observation from antiquity whose sensitivity and specificity cannot replace modern testing, and it should be viewed rationally. The associations with pain, fright, and uterine bleeding represent traditional pathological categorization and cannot be mapped to specific diseases.
The stirring pulse is mostly associated with emotional fright, painful states, and yin-yang conflict. In daily life, one should maintain emotional stability, avoiding prolonged tension, fright, and irritability; if pain recurs or abnormal bleeding such as uterine hemorrhage occurs, seek medical attention promptly rather than self-diagnosing solely by pulse. As for the classical pregnancy pulse, modern medical testing should govern definitively.
— Bugu Reminder: This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and research. It does not constitute any medical diagnosis, medication, or treatment advice. Please consult a qualified physician promptly if you are unwell.